Healthcare Provider Details

I. General information

NPI: 1003307471
Provider Name (Legal Business Name): KIRSI JOHANNA HADLEY MSN, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSI JOHANNA SAVONEN BSN, RN

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 STOCKTON RD
JOPPA MD
21085-1410
US

IV. Provider business mailing address

1312 STOCKTON RD
JOPPA MD
21085-1410
US

V. Phone/Fax

Practice location:
  • Phone: 443-616-1965
  • Fax:
Mailing address:
  • Phone: 443-616-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR191846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: