Provider Demographics
NPI:1093346124
Name:NLEND, PHYLICIA ANNE FRIEDA (PA)
Entity Type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:ANNE FRIEDA
Last Name:NLEND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIDGELY AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1045
Mailing Address - Country:US
Mailing Address - Phone:410-266-8049
Mailing Address - Fax:410-266-8054
Practice Address - Street 1:600 RIDGELY AVE STE 222
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1073
Practice Address - Country:US
Practice Address - Phone:410-266-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MDC07392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant