MEDICARE: MS. BETH ANN WADDELL-VANDEGEIJN 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	363LA2200X	Adult Health Nurse Practitioner	R112485	MD

General Provider Information

NPI Number	:	1275535452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETH ANN WADDELL-VANDEGEIJN CRNP

Provider Business Mailing Address
First Line	:	3100 WYMAN PARK DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-2803
Country	:	US
Telephone Number	:	410-338-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 DUNDALK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-3714
Country	:	US
Telephone Number	:	410-288-4800
Fax Number	:	410-288-1424

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/10/2011

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