Organization · Type 2 NPI
The Practitioner Provider LLC
Nurse Practitioner · Baltimore, MD
Practice location
424 E 30th St
Baltimore, MD 21218-3934
Fax (206) 752-6808
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | None listed |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1083587562
The Practitioner Provider LLC's National Provider Identifier is 1083587562, issued on Sep 29, 2025. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Baltimore, MD. The record was last updated on Aug 13, 2026.