Healthcare Provider Details

I. General information

NPI: 1386924991
Provider Name (Legal Business Name): ELEANOR DORIS MERBOTH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELEANOR COCHRAN CRNP

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 DOBBIN RD.
COLUMBIA MD
21045
US

IV. Provider business mailing address

6100 DOBBIN RD
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 443-492-4000
  • Fax:
Mailing address:
  • Phone: 443-492-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR173589
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: