1811102650 NPI number — PATRICIA WINCHESTER UNDERLAND M.S., CPNP

Table of content: PATRICIA WINCHESTER UNDERLAND M.S., CPNP (NPI 1811102650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811102650 NPI number — PATRICIA WINCHESTER UNDERLAND M.S., CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERLAND
Provider First Name:
PATRICIA
Provider Middle Name:
WINCHESTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811102650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
781 LEISTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-7440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-614-0834
Provider Business Mailing Address Fax Number:
410-502-5114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 RUTLAND AVE ROSS 1125
Provider Second Line Business Practice Location Address:
JOHNS HOPKINS UNIVERSITY
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-614-0834
Provider Business Practice Location Address Fax Number:
410-502-5114
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  RO82476 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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