Provider Demographics
NPI:1043579899
Name:CHOTIKUL, LIANA G (CRNP)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:G
Last Name:CHOTIKUL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N CALVERT ST STE 655
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6516
Mailing Address - Country:US
Mailing Address - Phone:410-554-2175
Mailing Address - Fax:410-554-2917
Practice Address - Street 1:3333 N CALVERT ST STE 655
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6516
Practice Address - Country:US
Practice Address - Phone:410-554-2175
Practice Address - Fax:410-554-2917
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR080135363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health