Basic Information
Provider Information | |||||||||
NPI: | 1689338931 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ERRERA | ||||||||
FirstName: | AJA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7580 BUCKINGHAM BLVD STE 220 | ||||||||
Address2: |   | ||||||||
City: | HANOVER | ||||||||
State: | MD | ||||||||
PostalCode: | 210763210 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4107295100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 125 SHOREWAY DR STE 120 | ||||||||
Address2: |   | ||||||||
City: | QUEENSTOWN | ||||||||
State: | MD | ||||||||
PostalCode: | 216581681 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108274001 | ||||||||
FaxNumber: | 4108274333 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/22/2021 | ||||||||
LastUpdateDate: | 11/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R207358 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.