Healthcare Provider Details

I. General information

NPI: 1730669771
Provider Name (Legal Business Name): MARILYN C HERNANDEZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 FIELDCREST DR
WHITE MARSH MD
21162-1143
US

IV. Provider business mailing address

5700 FIELDCREST DR
WHITE MARSH MD
21162-1143
US

V. Phone/Fax

Practice location:
  • Phone: 410-497-0990
  • Fax:
Mailing address:
  • Phone: 410-497-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR171573
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: