Healthcare Provider Details

I. General information

NPI: 1346514536
Provider Name (Legal Business Name): BARBARA LEE NALLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9658 MARLBORO PIKE
UPPER MARLBORO MD
20772
US

IV. Provider business mailing address

9658 MARLBORO PIKE
UPPER MARLBORO MD
20772
US

V. Phone/Fax

Practice location:
  • Phone: 240-788-7502
  • Fax: 240-838-5184
Mailing address:
  • Phone: 240-788-7502
  • Fax: 240-838-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR166920
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR166920
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: