Healthcare Provider Details

I. General information

NPI: 1881000859
Provider Name (Legal Business Name): DELORES B TURNER-BROCK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD COURT RD
RANDALLSTOWN MD
21133
US

IV. Provider business mailing address

886 AMHERST LN
WESTMINSTER MD
21158-3440
US

V. Phone/Fax

Practice location:
  • Phone: 410-701-4377
  • Fax: 410-655-7190
Mailing address:
  • Phone: 717-479-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR165096
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR165096
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: