Healthcare Provider Details

I. General information

NPI: 1538700844
Provider Name (Legal Business Name): EUTIERRIA HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BRYAN WAY STE A
REISTERSTOWN MD
21136-5958
US

IV. Provider business mailing address

203 BRYAN WAY STE A
REISTERSTOWN MD
21136-5958
US

V. Phone/Fax

Practice location:
  • Phone: 410-852-1020
  • Fax:
Mailing address:
  • Phone: 410-852-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HELEN ANOKHIN-MOGILNAY
Title or Position: OWNER
Credential: CRNP
Phone: 410-852-1020