Provider Demographics
NPI:1598778680
Name:HORSEMAN, MARY L (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:HORSEMAN
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 1:511 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3888
Mailing Address - Country:US
Mailing Address - Phone:410-822-6005
Mailing Address - Fax:410-822-9253
Practice Address - Street 1:511 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3888
Practice Address - Country:US
Practice Address - Phone:410-822-6005
Practice Address - Fax:410-822-9253
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR094441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ29331Medicare UPIN