Healthcare Provider Details

I. General information

NPI: 1417320581
Provider Name (Legal Business Name): INDRE BESASPARYTE DOYLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INDRE BESASPARYTE

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S DIVISION ST SUITE A, PENINSULA REGIONAL ENDOCRINOLOGY
SALISBURY MD
21804-7291
US

IV. Provider business mailing address

1415 S DIVISION ST SUITE A, PENINSULA REGIONAL ENDOCRINOLOGY
SALISBURY MD
21804-7291
US

V. Phone/Fax

Practice location:
  • Phone: 410-572-8848
  • Fax: 410-572-6890
Mailing address:
  • Phone: 410-572-8848
  • Fax: 410-572-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001663
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: