Provider Demographics
NPI:1073212908
Name:DENISE, MICHAL ALIZA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:ALIZA
Last Name:DENISE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 WOODCOURT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2521
Mailing Address - Country:US
Mailing Address - Phone:408-621-5775
Mailing Address - Fax:
Practice Address - Street 1:5101 LANIER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5321
Practice Address - Country:US
Practice Address - Phone:410-601-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily