Healthcare Provider Details

I. General information

NPI: 1548612799
Provider Name (Legal Business Name): MOBILE NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 MCDONOGH RD
RANDALLSTOWN MD
21133-3633
US

IV. Provider business mailing address

3927 MCDONOGH RD
RANDALLSTOWN MD
21133-3633
US

V. Phone/Fax

Practice location:
  • Phone: 410-963-5535
  • Fax: 410-655-2969
Mailing address:
  • Phone: 410-963-5535
  • Fax: 410-655-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberR158140
License Number StateMD

VIII. Authorized Official

Name: MRS. VERONICA ANNETTE HOLLAND-BARNER
Title or Position: NURSE PRACTITIONER
Credential: C.R.N.P
Phone: 410-963-5535