Healthcare Provider Details

I. General information

NPI: 1548419476
Provider Name (Legal Business Name): MAIREN L BAUNHOFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAIREN L HOLLAND NP

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 CATHAGE RD
BERLIN MD
21811
US

IV. Provider business mailing address

30265 COMMERCE DR UNIT 207
MILLSBORO DE
19966-3727
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-6104
  • Fax:
Mailing address:
  • Phone: 410-912-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR169373
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: