Provider Demographics
NPI:1811102650
Name:UNDERLAND, PATRICIA WINCHESTER (MS, CPNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WINCHESTER
Last Name:UNDERLAND
Suffix:
Gender:F
Credentials:MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 LEISTER DR
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-7440
Mailing Address - Country:US
Mailing Address - Phone:410-614-0834
Mailing Address - Fax:410-502-5114
Practice Address - Street 1:720 RUTLAND AVE ROSS 1125
Practice Address - Street 2:JOHNS HOPKINS UNIVERSITY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205
Practice Address - Country:US
Practice Address - Phone:410-614-0834
Practice Address - Fax:410-502-5114
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO82476363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics