Provider Demographics
NPI:1689935413
Name:MARRIOTT, KAREN TRACY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:TRACY
Last Name:MARRIOTT
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 1:66 PAINTERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3641
Mailing Address - Country:US
Mailing Address - Phone:443-394-0520
Mailing Address - Fax:
Practice Address - Street 1:66 PAINTERS MILL RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3641
Practice Address - Country:US
Practice Address - Phone:443-394-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063123363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health