Healthcare Provider Details

I. General information

NPI: 1770709578
Provider Name (Legal Business Name): SUSAN RENEE TOKARCIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 A ST SW
GLEN BURNIE MD
21061-3406
US

IV. Provider business mailing address

7866 POPLAR GROVE RD
SEVERN MD
21144-2023
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-6633
  • Fax:
Mailing address:
  • Phone: 410-969-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR083574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: