Healthcare Provider Details

I. General information

NPI: 1467766246
Provider Name (Legal Business Name): ELAINE MARIE SLEAR CRNP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DIGITAL DR STE G
LINTHICUM MD
21090-2267
US

IV. Provider business mailing address

2003 W FULTON ST
CHICAGO IL
60612-2345
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-3060
  • Fax:
Mailing address:
  • Phone: 177-329-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0047878-21
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: