MEDICARE: MOBILE MEMORY AND HEALTH, LLC

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	R121770	MD

General Provider Information

NPI Number	:	1487968699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MEMORY AND HEALTH, LLC

Provider Business Mailing Address
First Line	:	2893 EVERGREEN WAY
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-1052
Country	:	US
Telephone Number	:	410-627-5213
Fax Number	:

Provider Business Practice Location Address
First Line	:	2893 EVERGREEN WAY
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-1052
Country	:	US
Telephone Number	:	410-627-5213
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ELIZABETH MARIE GALIK
Credential	:	PHD, CRNP
Telephone Number	:	410-627-5213

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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