Healthcare Provider Details

I. General information

NPI: 1508148768
Provider Name (Legal Business Name): ELLEN KELLY JOYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

1100 E WHEEL RD
BEL AIR MD
21015-6344
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-1356
  • Fax: 410-337-1556
Mailing address:
  • Phone: 410-227-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR161697
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR161697
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: