Provider Demographics
NPI:1184175440
Name:BLACK NURSES ROCK - BALTIMORE. MD CHAPTER
Entity type:Organization
Organization Name:BLACK NURSES ROCK - BALTIMORE. MD CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROD-OWUAMANA
Authorized Official - Suffix:
Authorized Official - Credentials:HBOT
Authorized Official - Phone:410-921-8696
Mailing Address - Street 1:PO BOX 44367
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-6367
Mailing Address - Country:US
Mailing Address - Phone:410-921-8696
Mailing Address - Fax:
Practice Address - Street 1:7017 HAMLET AVENUE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:410-921-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization