Provider Demographics
NPI:1265102545
Name:FNP CONCIERGE HOME MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:FNP CONCIERGE HOME MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MYSIUK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-271-0335
Mailing Address - Street 1:2339 MAYTIME DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1434
Mailing Address - Country:US
Mailing Address - Phone:410-271-0335
Mailing Address - Fax:
Practice Address - Street 1:2339 MAYTIME DR
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1434
Practice Address - Country:US
Practice Address - Phone:410-271-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty