MEDICARE: REBECCA RODRIGUEZ CIRRI STUDENT NP

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	R114468	MD
2	363LF0000X	Family Nurse Practitioner	R114468	MD

General Provider Information

NPI Number	:	1699425694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RODRIGUEZ CIRRI STUDENT NP

Provider Business Mailing Address
First Line	:	7231 PARKWAY DR STE 100
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-2331
Country	:	US
Telephone Number	:	410-598-9430
Fax Number	:	410-424-4728

Provider Business Practice Location Address
First Line	:	7231 PARKWAY DR STE 100
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-2331
Country	:	US
Telephone Number	:	410-598-9430
Fax Number	:	410-424-4728

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

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	10/11/2024

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