Provider Demographics
NPI:1417540550
Name:MARYLAND, DENISE LALANDRA
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LALANDRA
Last Name:MARYLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 OLD YELLOW SPRINGS RD APT G
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2484
Mailing Address - Country:US
Mailing Address - Phone:252-813-8780
Mailing Address - Fax:
Practice Address - Street 1:85 OLD YELLOW SPRINGS RD APT G
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2484
Practice Address - Country:US
Practice Address - Phone:252-813-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302160163W00000X
OHRN.436229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse