Provider Demographics
NPI:1366771826
Name:NELIS, MAUREEN (LACBOARD CERTIFIED)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:NELIS
Suffix:
Gender:F
Credentials:LACBOARD CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 MYSTIC CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1856
Mailing Address - Country:US
Mailing Address - Phone:410-740-0080
Mailing Address - Fax:
Practice Address - Street 1:9170 ROUTE 108 STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1988
Practice Address - Country:US
Practice Address - Phone:410-740-0080
Practice Address - Fax:410-730-1172
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1281171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist