Basic Information
| Provider Information | |||||||||
| NPI: | 1942359724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SYBRANT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 CHICKORY WAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197112595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027388977 | ||||||||
| FaxNumber: | 8778035453 | ||||||||
| Practice Location | |||||||||
| Address1: | 6085 MARSHALEE DR | ||||||||
| Address2: | SUITE 110 MD030-1000 | ||||||||
| City: | ELKRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210756023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025594446 | ||||||||
| FaxNumber: | 4103793591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LG0600X | LB-0000188 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.