=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003623927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN BRYAN PILARIZA ANNANG CRNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2024
-----------------------------------------------------
Last Update Date | 12/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 273 PENINSULA FARM RD STE F
-----------------------------------------------------
City | ARNOLD
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21012-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-827-7113
-----------------------------------------------------
Fax | 443-200-0265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 COFFEEN AVE STE 1200
-----------------------------------------------------
City | SHERIDAN
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82801-5777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AC007109
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------