Basic Information
| Provider Information | |||||||||
| NPI: | 1720088560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYERLE | ||||||||
| FirstName: | ROSEMARY | ||||||||
| MiddleName: | HIGGINS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.R.N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HIGGINS | ||||||||
| OtherFirstName: | ROSEMARY | ||||||||
| OtherMiddleName: | THERESA | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | C.R.N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 MITCHELLVILLE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012625900 | ||||||||
| FaxNumber: | 4107410865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R079903 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 037632 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 7375010 | 01 | MD | AETNA PPO | OTHER | 7605-0013 | 01 | MD | CAREFIRST BLUECHOICE | OTHER | 212791100 | 05 | MD | MEDICAID | 500006653 | 01 | MD | RAILROAD MEDICARE | OTHER | 527545-08 | 01 | MD | CAREFIRST MD RENDERING | OTHER | 6279512 | 01 | MD | AETNA HMO | OTHER |