MEDICARE: SYREETA LENAE STARNES M.S.N PHN RN

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	163W00000X	Registered Nurse	R208514	MD

General Provider Information

NPI Number	:	1093036899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYREETA LENAE STARNES M.S.N PHN RN

Provider Business Mailing Address
First Line	:	7055 SAMUEL MORSE DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3439
Country	:	US
Telephone Number	:	410-910-6700
Fax Number	:	410-910-6700

Provider Business Practice Location Address
First Line	:	7055 SAMUEL MORSE DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3439
Country	:	US
Telephone Number	:	410-910-6700
Fax Number	:	410-910-6700

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

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	09/23/2014

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