Healthcare Provider Details

I. General information

NPI: 1235126178
Provider Name (Legal Business Name): MARIJO COSMAS MS, RN, AOCN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 STEEPLE CHASE DR SUITE 404
PRINCE FREDERICK MD
20678-4049
US

IV. Provider business mailing address

301 STEEPLE CHASE DR SUITE 404
PRINCE FREDERICK MD
20678-4049
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2811
  • Fax: 410-535-1865
Mailing address:
  • Phone: 410-535-2811
  • Fax: 410-535-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR059234
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: