Provider Demographics
NPI:1841222973
Name:WORRALL-FELDHAUSEN, ROBERTA (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:WORRALL-FELDHAUSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:410-469-3085
Practice Address - Street 1:3110 GRACEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1820
Practice Address - Country:US
Practice Address - Phone:301-572-8340
Practice Address - Fax:301-572-8403
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR119532364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0943SE-643880-01OtherCAREFIRST BCBS OF MD
8302101OtherEVERCARE
0041OtherCAREFRIST
0943ER-643880-01OtherCAREFIRST BCBS OF MD
64388001OtherBCBS
9680-0019OtherCAREFIRST BCBS OF DC
015418S32Medicare PIN
0943SE-643880-01OtherCAREFIRST BCBS OF MD
011860S32Medicare PIN