Provider Demographics
NPI:1083637243
Name:PAULDINE, ELIZABETH FELL (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FELL
Last Name:PAULDINE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-526-8310
Mailing Address - Fax:410-526-8316
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-526-8310
Practice Address - Fax:410-526-8316
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137433163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699007000Medicaid
P24699Medicare UPIN
MDH348C529Medicare ID - Type Unspecified