Provider Demographics
NPI:1588667943
Name:HOSTOVICH, LAURA M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:HOSTOVICH
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 1:600 N WOLFE ST
Mailing Address - Street 2:WEINBERG BUILDING ROOM 1123
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-3525
Mailing Address - Country:US
Mailing Address - Phone:410-614-4501
Mailing Address - Fax:443-287-0108
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:WEINBERG BUILDING ROOM 1123
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-614-4501
Practice Address - Fax:443-287-0108
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR157428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016519H21Medicare ID - Type Unspecified
MDQ38236Medicare UPIN