Provider Demographics
NPI:1982658753
Name:REILLY, MICHELE L (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:REILLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:129 LUBRANO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7567
Mailing Address - Country:US
Mailing Address - Phone:410-573-0090
Mailing Address - Fax:410-573-0097
Practice Address - Street 1:129 LUBRANO DR STE 201C
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7567
Practice Address - Country:US
Practice Address - Phone:410-573-0097
Practice Address - Fax:410-573-0097
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303769-1363LA2200X
MDR240245363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health