MEDICARE: JOAN MALDONADO-RESTO 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	R176154	MD

General Provider Information

NPI Number	:	1689157430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN MALDONADO-RESTO CRNP

Provider Business Mailing Address
First Line	:	PO BOX 1602
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-1663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3995 OLD TOWN RD
Second Line	:
City	:	HUNTINGTOWN
State	:	MD
Zip	:	20639-3039
Country	:	US
Telephone Number	:	410-536-3612
Fax Number	:	410-535-3613

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	09/07/2018

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