Provider Demographics
NPI:1093714438
Name:MASTELLA, LAURA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MASTELLA
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 1:402 PATLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5632
Mailing Address - Country:US
Mailing Address - Phone:410-744-8114
Mailing Address - Fax:410-744-8757
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE 4105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:410-821-2800
Practice Address - Fax:410-821-2804
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084663363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS73514Medicare ID - Type Unspecified
MDP02073Medicare UPIN