Provider Demographics
NPI:1740364942
Name:CHASE, MARIAM M (MSN RN CS-P)
Entity type:Individual
Prefix:MRS
First Name:MARIAM
Middle Name:M
Last Name:CHASE
Suffix:
Gender:F
Credentials:MSN RN CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 SKIPWITH DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9499
Mailing Address - Country:US
Mailing Address - Phone:301-631-1863
Mailing Address - Fax:
Practice Address - Street 1:8818 GEORGIA AVE
Practice Address - Street 2:SUITE 501, FIRST FLOOR
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2713
Practice Address - Country:US
Practice Address - Phone:240-777-3353
Practice Address - Fax:240-777-1367
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR081733163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR081733OtherREGISTERED NURSE LICENSE