Healthcare Provider Details

I. General information

NPI: 1699303727
Provider Name (Legal Business Name): MODERN MEDICINE EXPRESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 CAMPBELL MEADOW RD
OWINGS MILLS MD
21117
US

IV. Provider business mailing address

1041 CAMPBELL MEADOW RD
OWINGS MILLS MD
21117-5039
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARRIETT NEVERDON
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 443-416-5868