Healthcare Provider Details

I. General information

NPI: 1891215281
Provider Name (Legal Business Name): MARCY RENEE KIRSCH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 BOILER HOUSE RD BLDG 361
PERRY POINT MD
21902-1103
US

IV. Provider business mailing address

117 STEAMBOAT CT
NORTH EAST MD
21901-2908
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-459-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR184829
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR184829
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: