Provider Demographics
NPI:1437913183
Name:NILLES, MADDELYN
Entity Type:Individual
Prefix:
First Name:MADDELYN
Middle Name:
Last Name:NILLES
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 1:3023 BELLECHASSE RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1008
Mailing Address - Country:US
Mailing Address - Phone:443-307-3110
Mailing Address - Fax:
Practice Address - Street 1:12 MEDSTAR BLVD STE 325
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1817
Practice Address - Country:US
Practice Address - Phone:410-877-8079
Practice Address - Fax:410-877-8079
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program