Healthcare Provider Details

I. General information

NPI: 1699425694
Provider Name (Legal Business Name): REBECCA RODRIGUEZ CIRRI STUDENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 PARKWAY DR STE 100
HANOVER MD
21076-2331
US

IV. Provider business mailing address

7231 PARKWAY DR STE 100
HANOVER MD
21076-2331
US

V. Phone/Fax

Practice location:
  • Phone: 410-598-9430
  • Fax: 410-424-4728
Mailing address:
  • Phone: 410-598-9430
  • Fax: 410-424-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR114468
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR114468
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: