Provider Demographics
NPI:1861451734
Name:ROCHELLE, MAUREEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:ROCHELLE
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 1:3938 WHITE ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5822
Mailing Address - Country:US
Mailing Address - Phone:410-750-7734
Mailing Address - Fax:410-461-8734
Practice Address - Street 1:2700 SEAMON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1117
Practice Address - Country:US
Practice Address - Phone:410-396-8048
Practice Address - Fax:410-396-8052
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO56461363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics