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General NPI Number Information
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NPI Number | 1285692418
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Entity Type | Individual
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Provider Name | JOHN W DISTLER FNP
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 844 WASHINGTON ROAD SUITE 201
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City | WESTMINSTER
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State | MD
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Zip | 21157-3035
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Country | US
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Telephone | 410-857-7900
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Fax | 410-857-1150
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Provider Business Mailing Address
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Address Line | 2800 QUARRY LAKE DRIVE 100
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City | BALTIMORE
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State | MD
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Zip | 21209-3770
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Country | US
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Telephone | 410-486-2000
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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 | R147365
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License Number State | MD
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