Provider Demographics
NPI:1417070657
Name:TAHERIAN, MARIAM HALICIA (RN)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:HALICIA
Last Name:TAHERIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:HALICIA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:791 AQUAHART ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-222-6625
Mailing Address - Fax:410-222-6679
Practice Address - Street 1:791 AQUAHART ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-222-6625
Practice Address - Fax:410-222-6679
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149473163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health