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General NPI Number Information
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NPI Number | 1073212908
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Entity Type | Individual
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Provider Name | MICHAL ALIZA DENISE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 5101 LANIER AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5321
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Country | US
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Telephone | 410-601-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 2719 WOODCOURT RD
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City | BALTIMORE
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State | MD
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Zip | 21209-2521
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Country | US
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Telephone | 408-621-5775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R209587
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License Number State | MD
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