Healthcare Provider Details

I. General information

NPI: 1730361510
Provider Name (Legal Business Name): MARY ANN WIPPEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK RD STE 506
LUTHERVILLE MD
21093-6022
US

IV. Provider business mailing address

1145 MAIN ST
DARLINGTON MD
21034-1405
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-2281
  • Fax: 410-825-2280
Mailing address:
  • Phone: 410-457-4689
  • Fax: 410-457-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR115364
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: