Provider Demographics
NPI:1467669705
Name:NEUMANN, MARY AGNESE (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AGNESE
Last Name:NEUMANN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 BROOKVIEW RD
Mailing Address - Street 2:UNIT 404
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6043
Mailing Address - Country:US
Mailing Address - Phone:410-799-5896
Mailing Address - Fax:
Practice Address - Street 1:7325 BROOKVIEW RD
Practice Address - Street 2:UNIT 404
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6043
Practice Address - Country:US
Practice Address - Phone:410-799-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN49963363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health