Provider Demographics
NPI:1093933160
Name:MICHAEL, MEREDITH ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12723 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1134
Mailing Address - Country:US
Mailing Address - Phone:410-222-6519
Mailing Address - Fax:
Practice Address - Street 1:791 AQUAHART RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3961
Practice Address - Country:US
Practice Address - Phone:410-222-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR092521163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool