Provider Demographics
NPI:1275711525
Name:BROSI, MARJORIE MUTH (RN, LAC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MUTH
Last Name:BROSI
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 GENERALS HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2060
Mailing Address - Country:US
Mailing Address - Phone:410-923-0090
Mailing Address - Fax:
Practice Address - Street 1:1321 GENERALS HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2060
Practice Address - Country:US
Practice Address - Phone:410-923-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1415171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist