Provider Demographics
NPI:1841528304
Name:FREND, MINDI L (CRNP)
Entity type:Individual
Prefix:
First Name:MINDI
Middle Name:L
Last Name:FREND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MINDI
Other - Middle Name:L
Other - Last Name:BOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8040
Mailing Address - Fax:443-462-3514
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1590
Practice Address - Country:US
Practice Address - Phone:410-328-7877
Practice Address - Fax:410-328-1048
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR135139363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS053-0068OtherBLUE CROSS REGIONAL
MD419174900Medicaid
MD960517-01OtherBLUE CROSS/BLUE SHIELD
MDS062-0451OtherCAREFIRST - REGIONAL
MDP01267660Medicare PIN
MDS053-0068OtherBLUE CROSS REGIONAL
MD173034ZAQPMedicare PIN