Provider Demographics
NPI:1306311717
Name:MAMEDOV, NANETTE GABRIELLE (CRNP-FAMILY)
Entity type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:GABRIELLE
Last Name:MAMEDOV
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:MS
Other - First Name:NANETTE
Other - Middle Name:GABRIELLE
Other - Last Name:GILKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP-FAMILY
Mailing Address - Street 1:7601 OSLER DR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7700
Mailing Address - Country:US
Mailing Address - Phone:410-337-1000
Mailing Address - Fax:
Practice Address - Street 1:7601 OSLER DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7700
Practice Address - Country:US
Practice Address - Phone:410-337-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184664364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health