Provider Demographics
NPI:1770772196
Name:URBONOWICZ, ANNARUTH KELLEY (CPNP)
Entity type:Individual
Prefix:MS
First Name:ANNARUTH
Middle Name:KELLEY
Last Name:URBONOWICZ
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:RUTH
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1792 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222
Mailing Address - Country:US
Mailing Address - Phone:410-284-1133
Mailing Address - Fax:410-284-3371
Practice Address - Street 1:1792 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-284-1133
Practice Address - Fax:410-284-3371
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR159487208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52-2168754OtherTIN