Provider Demographics
NPI:1528763729
Name:BANNERMAN, DOREEN (CRNP)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:BANNERMAN
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 1:4 W ROLLING XRDS STE 100
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6277
Mailing Address - Country:US
Mailing Address - Phone:410-869-0100
Mailing Address - Fax:410-601-7317
Practice Address - Street 1:4 W ROLLING XRDS STE 100
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6277
Practice Address - Country:US
Practice Address - Phone:410-869-0100
Practice Address - Fax:410-601-7317
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221808363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health