Healthcare Provider Details

I. General information

NPI: 1508311150
Provider Name (Legal Business Name): DAWN MARIE ROELOFS NP-C, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7962 COVINGTON AVE
GLEN BURNIE MD
21061-4875
US

IV. Provider business mailing address

7962 COVINGTON AVE
GLEN BURNIE MD
21061-4875
US

V. Phone/Fax

Practice location:
  • Phone: 410-245-1806
  • Fax:
Mailing address:
  • Phone: 410-245-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR143946
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR143946
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN669051
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1038448
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: