Provider Demographics
NPI:1780170191
Name:MANN, ALIESHA NICOLE (CRNP)
Entity type:Individual
Prefix:
First Name:ALIESHA
Middle Name:NICOLE
Last Name:MANN
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 1:1600 CRAIN HWY S STE 401
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6413
Mailing Address - Country:US
Mailing Address - Phone:410-768-5050
Mailing Address - Fax:410-768-7830
Practice Address - Street 1:1600 CRAIN HWY S STE 401
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-768-5050
Practice Address - Fax:410-768-7830
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215651363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily