Provider Demographics
NPI:1285654855
Name:DEMARIO, KATHLEEN LOUZON (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUZON
Last Name:DEMARIO
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:2801 DEMARIO DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1987
Mailing Address - Country:US
Mailing Address - Phone:410-358-2397
Mailing Address - Fax:410-358-2399
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7620
Practice Address - Fax:410-209-8418
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR089949363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147951ZCVYMedicare PIN
MDS81866Medicare UPIN