Provider Demographics
NPI:1053719997
Name:DEMORY, OSSOLITA (RN)
Entity type:Individual
Prefix:MRS
First Name:OSSOLITA
Middle Name:
Last Name:DEMORY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAST ORDNANCE ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-2200
Mailing Address - Country:US
Mailing Address - Phone:410-222-4928
Mailing Address - Fax:410-222-6182
Practice Address - Street 1:600 EAST ORDNANCE ROAD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-2200
Practice Address - Country:US
Practice Address - Phone:410-222-4928
Practice Address - Fax:410-222-6182
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205577163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health