Provider Demographics
NPI:1063623866
Name:KELLERMANN, MARYE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARYE
Middle Name:
Last Name:KELLERMANN
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 1:31 BLONDELL CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2003
Mailing Address - Country:US
Mailing Address - Phone:410-494-0398
Mailing Address - Fax:410-494-1445
Practice Address - Street 1:31 BLONDELL CT
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-2003
Practice Address - Country:US
Practice Address - Phone:410-494-0398
Practice Address - Fax:410-494-1445
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO56576363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health