Healthcare Provider Details

I. General information

NPI: 1437140738
Provider Name (Legal Business Name): PHYLLIS A RUMORE-FARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23415 THREE NOTCH RD
CALIFORNIA MD
20619-4017
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 301-373-7900
  • Fax: 301-373-6900
Mailing address:
  • Phone: 410-933-6421
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR153692
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: