Basic Information
| Provider Information | |||||||||
| NPI: | 1912304486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOWERS | ||||||||
| FirstName: | WENDY | ||||||||
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| Credential: | CRNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 ELKRIDGE LANDING RD | ||||||||
| Address2: | |||||||||
| City: | LINTHICUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210902917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106842031 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30475 CRONWELLS WAY | ||||||||
| Address2: | |||||||||
| City: | TRAPPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216731703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103101449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2014 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | R101219 | MD | N | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 363L00000X | R101219 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.