MEDICARE: MRS. LACY TWINING PITMAN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R147334	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073598462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LACY TWINING PITMAN CRNP

Provider Business Mailing Address
First Line	:	100 HOSPITAL RD
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4017
Country	:	US
Telephone Number	:	410-535-4488
Fax Number	:	443-771-8114

Provider Business Practice Location Address
First Line	:	110 HOSPITAL RD STE 111
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4039
Country	:	US
Telephone Number	:	410-535-4488
Fax Number	:	443-771-8114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/16/2024

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