Provider Demographics
NPI:1851173132
Name:LOBO, PRISCILLA D
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:D
Last Name:LOBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7017
Mailing Address - Country:US
Mailing Address - Phone:504-782-1587
Mailing Address - Fax:
Practice Address - Street 1:7120 MINSTREL WAY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5274
Practice Address - Country:US
Practice Address - Phone:410-290-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR246141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily