Provider Demographics
NPI:1699303727
Name:MODERN MEDICINE EXPRESS CARE
Entity type:Organization
Organization Name:MODERN MEDICINE EXPRESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIETT
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVERDON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:443-416-5868
Mailing Address - Street 1:1041 CAMPBELL MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1041 CAMPBELL MEADOW RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN ESTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care