Healthcare Provider Details

I. General information

NPI: 1841746351
Provider Name (Legal Business Name): EMILY NICOLE MEYERL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 04/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 HEDGEROW WAY
NOTTINGHAM MD
21236-1918
US

IV. Provider business mailing address

2917 MONROE ST
COLUMBIA SC
29205-2551
US

V. Phone/Fax

Practice location:
  • Phone: 443-602-1296
  • Fax:
Mailing address:
  • Phone: 443-602-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: