Healthcare Provider Details

I. General information

NPI: 1801012646
Provider Name (Legal Business Name): MARY A CZAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MARYLAND HEALTH CTR 140 CAMPUS DRIVE
COLLEGE PARK MD
20742-0001
US

IV. Provider business mailing address

7311 ADELPHI RD
HYATTSVILLE MD
20783-1902
US

V. Phone/Fax

Practice location:
  • Phone: 301-314-8157
  • Fax:
Mailing address:
  • Phone: 301-422-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberR125206
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: