Healthcare Provider Details

I. General information

NPI: 1255943502
Provider Name (Legal Business Name): NURSE PRACTITIONER SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT MARYS AVE # 101
LA PLATA MD
20646-4037
US

IV. Provider business mailing address

1 SAINT MARYS AVE STE 101
LA PLATA MD
20646-4037
US

V. Phone/Fax

Practice location:
  • Phone: 240-257-5436
  • Fax:
Mailing address:
  • Phone: 240-257-5436
  • Fax: 301-327-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA BEHM
Title or Position: CO-OWNER, NURSE PRACTITIONER
Credential: DNP, FNP-C
Phone: 240-257-5436