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NPI Code Detail

MEDICARE: RENEE BOLDEN PURDY RN

MEDICARE: RENEE BOLDEN PURDY RN
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
1163W00000XRegistered NurseR154204MD

General Provider Information

NPI Number : 1700150844
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE BOLDEN PURDY RN
Provider Business Mailing Address
First Line : 10440 LITTLE PATUXENT PKWY STE 800
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3569
Country : US
Telephone Number : 443-832-7411
Fax Number : 443-276-6478
Provider Business Practice Location Address
First Line : 10440 LITTLE PATUXENT PKWY STE 800
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3569
Country : US
Telephone Number : 443-832-7411
Fax Number : 443-276-6478
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2012
Last Update Date : 06/11/2020

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