Healthcare Provider Details

I. General information

NPI: 1003383779
Provider Name (Legal Business Name): SANCHEZ BROWN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 100
COLUMBIA MD
21045-3263
US

IV. Provider business mailing address

630 S EXETER ST
BALTIMORE MD
21202-4316
US

V. Phone/Fax

Practice location:
  • Phone: 410-689-7400
  • Fax:
Mailing address:
  • Phone: 410-962-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR153998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: