Provider Demographics
NPI:1184013823
Name:OBEISSANT, MARYSE (RN)
Entity Type:Individual
Prefix:
First Name:MARYSE
Middle Name:
Last Name:OBEISSANT
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 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 417
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:443-725-2665
Mailing Address - Fax:
Practice Address - Street 1:9601 PULASKI PARK DR
Practice Address - Street 2:SUITE 417
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-1409
Practice Address - Country:US
Practice Address - Phone:443-725-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse