Healthcare Provider Details

I. General information

NPI: 1477604726
Provider Name (Legal Business Name): AMY L. WOJCIK C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

PO BOX 79035
BALTIMORE MD
21279-0035
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-1000
  • Fax:
Mailing address:
  • Phone: 410-337-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR128546
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: