Basic Information
| Provider Information | |||||||||
| NPI: | 1558390765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PREIS | ||||||||
| FirstName: | JUSTINE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 MAIDEN CHOICE LN | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212285968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108823240 | ||||||||
| FaxNumber: | 4106615093 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 WALTHER BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212349001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108823240 | ||||||||
| FaxNumber: | 4106615093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R043580 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 093NER-606567-01 | 01 | CAREFIRST BCBS OF MD | OTHER | 093NSE-606567-01 | 01 | CAREFIRST BCBS OF MD | OTHER | 60656701 | 01 | BCBS | OTHER | 8300981 | 01 | EVERCARE | OTHER | 9676-0027 | 01 | CAREFIRST BCBS OF DC | OTHER | 0943ER-606567-02 | 01 | CAREFIRST BCBS OF MD | OTHER | 280003900 | 05 | MD | MEDICAID | 0018 | 01 | CAREFIRST | OTHER |