Healthcare Provider Details

I. General information

NPI: 1558094995
Provider Name (Legal Business Name): GRACE NOLASCO RAMOS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 BELAIR RD STE D
NOTTINGHAM MD
21236-1605
US

IV. Provider business mailing address

9309 BELAIR RD STE D
NOTTINGHAM MD
21236-1605
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-7952
  • Fax: 410-701-3845
Mailing address:
  • Phone: 410-505-7952
  • Fax: 410-701-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number158675
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: