Healthcare Provider Details

I. General information

NPI: 1245530864
Provider Name (Legal Business Name): AMY JO NOLDE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 7TH ST
FREDERICK MD
21701-4506
US

IV. Provider business mailing address

400 W 7TH ST
FREDERICK MD
21701-4506
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-3300
  • Fax: 240-566-4872
Mailing address:
  • Phone: 240-566-3300
  • Fax: 240-566-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License NumberL04671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: