Provider Demographics
NPI:1558390765
Name:PREIS, JUSTINE (CRNP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:PREIS
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 1:701 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5968
Mailing Address - Country:US
Mailing Address - Phone:410-882-3240
Mailing Address - Fax:410-661-5093
Practice Address - Street 1:8800 WALTHER BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-9001
Practice Address - Country:US
Practice Address - Phone:410-882-3240
Practice Address - Fax:410-661-5093
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR043580363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
093NER-606567-01OtherCAREFIRST BCBS OF MD
093NSE-606567-01OtherCAREFIRST BCBS OF MD
60656701OtherBCBS
8300981OtherEVERCARE
9676-0027OtherCAREFIRST BCBS OF DC
0943ER-606567-02OtherCAREFIRST BCBS OF MD
MD280003900Medicaid
0018OtherCAREFIRST
0018OtherCAREFIRST
60656701OtherBCBS
MDS34976Medicare UPIN