Provider Demographics
NPI:1124483029
Name:CHETTIAR, ROSHNI LIZ (CRNP)
Entity type:Individual
Prefix:
First Name:ROSHNI
Middle Name:LIZ
Last Name:CHETTIAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5267
Mailing Address - Country:US
Mailing Address - Phone:301-560-4747
Mailing Address - Fax:301-776-1725
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2374
Practice Address - Country:US
Practice Address - Phone:301-560-4747
Practice Address - Fax:301-776-1725
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR187321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily