Healthcare Provider Details

I. General information

NPI: 1154046738
Provider Name (Legal Business Name): MARISSA ASHLEY PERKINS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8894 STANFORD BLVD
COLUMBIA MD
21045-4794
US

IV. Provider business mailing address

8894 STANFORD BLVD STE 104
COLUMBIA MD
21045-5161
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-7246
  • Fax:
Mailing address:
  • Phone: 410-997-7226
  • Fax: 410-997-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR230832
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: