MRS. LACREASHA FULLARD (NPI# 1821696196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821696196 |
| Entity Type | Individual |
| Full Name | MRS. LACREASHA FULLARD |
| Credential | PMHNP-BC |
| Practice Address |
7207 Baltimore Annapolis Blvd Glen Burnie MD 21061-2684 |
| Practice Telephone | 4107667300 |
| Mailing Telephone | 4107667300 |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
R219476 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
7207 BALTIMORE ANNAPOLIS BLVD |
| City | GLEN BURNIE |
| State | MD |
| Zip Code | 21061-2684 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891717757 | Archil Abashidze | Psychiatry & Neurology | 7207 Baltimore Annapolis Blvd, Glen Burnie, MD 21061-2684 | 2006-07-23 |
| 1053920686 | Becky Tatani | Counselor | 7207 Baltimore Annapolis Blvd, Glen Burnie, MD 21061-2684 | 2020-07-29 |
| 1952816951 | Marjorie Lynne Gold | Counselor | 7207 Baltimore Annapolis Blvd, Glen Burnie, MD 21061-2684 | 2017-12-12 |
| 1982127650 | Maryelizabeth Anne Kurz | Counselor | 7207 Baltimore Annapolis Blvd, Glen Burnie, MD 21061-2684 | 2017-07-25 |
| 1730482464 | Noah J Miller | Nurse Practitioner | 7207 Baltimore Annapolis Blvd, Glen Burnie, MD 21061-2684 | 2010-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255814422 | Lotus Behavioral Health and Rehabilitation Services Inc. | Behavior Technician | 6426 Harrison Square, Glen Burnie, MD 21061 | 2018-09-12 |
| 1942795315 | Tina Brown | Behavior Technician | Rise for Autism, 510 Mccormick Drive, Ste. U-w, Glen Burnie, MD 21061 | 2018-06-27 |
| 1205351905 | Digna Emerita Sanchez De Vasquez | Specialist/Technologist, Other | 201 Fernglen Ave, Glen Burnie, MD 21061 | 2017-08-03 |
| 1255780300 | Rachel Cutts | Physical Therapist | 7711 Quarterfield Rd Ste C2, Glen Burnie, MD 21061 | 2016-06-09 |
| 1295181170 | Gaudenzia, Inc. | Counselor | 5 Crain Highway North - Rear Suite Entrance, Glen Burnie, MD 21061 | 2016-05-10 |
| 1023499548 | Mary Bourbon | Nurse Practitioner | 1600 S. Cain Highway, Suite 401, Glen Burnie, MD 21061 | 2015-06-10 |
| 1972997724 | Robert Oladeinde | Physician Assistant | 6934 Aviation Blvd Suite B, Glen Burnie, MD 21061 | 2015-03-18 |
| 1205248069 | Cathy Qing He | Anesthesiology | 1600 Crain Hwy S Ste 301, Glen Burnie, MD 21061 | 2014-05-28 |
| 1477974764 | Shannon Holder | Nurse Practitioner | 1916 Crain Hwy S Ste 2, Glen Burnie, MD 21061 | 2014-01-03 |
| 1629404207 | Marla Ann Muha | Physician Assistant | 301 Hospital Dr # 803, Glen Burnie, MD 21061 | 2013-09-16 |
| Find all providers in zip 21061 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376177097 | Edith Osei | Nurse Practitioner | 718 Columbus Dr, Glen Burnie, MD 21061-4990 | 2020-03-03 |
| 1437798923 | Ic Health Services Inc | Nurse Practitioner | 6710f Ritchie Hwy Ste 417, Glen Burnie, MD 21061-2319 | 2019-12-31 |
| 1003450206 | Equillibrium Health Care Services LLC | Nurse Practitioner | 6710f Ritchie Hwy # 417, Glen Burnie, MD 21061-2319 | 2019-10-30 |
| 1508428541 | Body Mind & Soul Family Services, LLC | Nurse Practitioner | 1401 Madison Park Dr Ste 201, Glen Burnie, MD 21061-5881 | 2019-06-30 |
| 1427317080 | Martin Nkemamin Nzefeh | Nurse Practitioner | 1406 Crain Hwy S # 104-106, Glen Burnie, MD 21061-4058 | 2012-05-16 |
| 1467460865 | Ilya Rozenberg | Nurse Practitioner | 7452 Baltimore Annapolis Blvd, Suite 107, Glen Burnie, MD 21061-3547 | 2006-08-03 |
| 1831702539 | Seven 2 Seven Medical Services LLC | Nurse Practitioner | 7678 Quarterfield Rd Ste 201, Glen Burnie, MD 21061-7071 | 2020-08-24 |
| 1003426065 | Epm Health Services | Nurse Practitioner | 718 Columbus Dr, Glen Burnie, MD 21061-4990 | 2020-08-05 |
| 1053961987 | Michael Nwandu | Nurse Practitioner | 7836 Oakwood Rd, Glen Burnie, MD 21061-4298 | 2019-09-12 |
| 1215599063 | Kara Beth Iacovella | Nurse Practitioner | 1419 Madison Park Dr, Glen Burnie, MD 21061-5613 | 2019-07-02 |
| Find all providers in GLEN BURNIE | ||||
| City | GLEN BURNIE |
| Zip Code | 21061 |
Please comment or provide details below to improve the information on MRS. LACREASHA FULLARD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.