Healthcare Provider Details

I. General information

NPI: 1265102545
Provider Name (Legal Business Name): FNP CONCIERGE HOME MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MAYTIME DR
GAMBRILLS MD
21054-1434
US

IV. Provider business mailing address

2339 MAYTIME DR
GAMBRILLS MD
21054-1434
US

V. Phone/Fax

Practice location:
  • Phone: 410-271-0335
  • Fax:
Mailing address:
  • Phone: 410-271-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA JEAN MYSIUK
Title or Position: EMPLOYEE
Credential: CRNP
Phone: 410-271-0335