Healthcare Provider Details

I. General information

NPI: 1508799735
Provider Name (Legal Business Name): MARISELA DAVIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720G RITCHIE HWY # 267
GLEN BURNIE MD
21061-2319
US

IV. Provider business mailing address

6720G RITCHIE HWY # 267
GLEN BURNIE MD
21061-2319
US

V. Phone/Fax

Practice location:
  • Phone: 410-994-2462
  • Fax:
Mailing address:
  • Phone: 410-994-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number264099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: