Healthcare Provider Details

I. General information

NPI: 1083637243
Provider Name (Legal Business Name): ELIZABETH FELL PAULDINE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH FELL

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN STREET SUITE 200
REISTERSTOWN MD
21136
US

IV. Provider business mailing address

25 MAIN STREET SUITE 200
REISTERSTOWN MD
21136
US

V. Phone/Fax

Practice location:
  • Phone: 410-526-8310
  • Fax: 410-526-8316
Mailing address:
  • Phone: 410-526-8310
  • Fax: 410-526-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR137433
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR137433
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: