Healthcare Provider Details

I. General information

NPI: 1073598462
Provider Name (Legal Business Name): LACY TWINING PITMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD STE 111
PRINCE FREDERICK MD
20678-4039
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4488
  • Fax: 443-771-8114
Mailing address:
  • Phone: 410-535-4488
  • Fax: 443-771-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR147334
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: