MEDICARE: MS. LAURA M HOSTOVICH 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	363L00000X	Nurse Practitioner	R157428	MD

General Provider Information

NPI Number	:	1588667943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA M HOSTOVICH CRNP

Provider Business Mailing Address
First Line	:	600 N WOLFE ST
Second Line	:	WEINBERG BUILDING ROOM 1123
City	:	BALTIMORE
State	:	MD
Zip	:	21287-3525
Country	:	US
Telephone Number	:	410-614-4501
Fax Number	:	443-287-0108

Provider Business Practice Location Address
First Line	:	600 N WOLFE ST
Second Line	:	WEINBERG BUILDING ROOM 1123
City	:	BALTIMORE
State	:	MD
Zip	:	21287-0005
Country	:	US
Telephone Number	:	410-614-4501
Fax Number	:	443-287-0108

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/29/2012

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