Healthcare Provider Details

I. General information

NPI: 1619519303
Provider Name (Legal Business Name): EMILY SAPP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD STE 18
DUNDALK MD
21222-2132
US

IV. Provider business mailing address

2 PARK CENTER CT STE 200
OWINGS MILLS MD
21117-4221
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-2946
  • Fax: 443-399-8039
Mailing address:
  • Phone: 410-571-2946
  • Fax: 443-450-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR212238
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR212238
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: