Provider Demographics
NPI:1063990448
Name:FURR, MYEISHA (NP)
Entity type:Individual
Prefix:
First Name:MYEISHA
Middle Name:
Last Name:FURR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 BAYONNE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2811
Mailing Address - Country:US
Mailing Address - Phone:443-722-7148
Mailing Address - Fax:
Practice Address - Street 1:9649 BELAIR RD FL 2
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1100
Practice Address - Country:US
Practice Address - Phone:410-256-9340
Practice Address - Fax:410-601-1052
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220621363LF0000X
MDF07182293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily