Provider Demographics
NPI:1679790810
Name:KNOTT-GRASSO, MARY ANN (MS, CPNP)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KNOTT-GRASSO
Suffix:
Gender:F
Credentials:MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 WINSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:410-323-7631
Mailing Address - Fax:
Practice Address - Street 1:HARRIET LANE CLINIC, JOHNS HOPKINS UNIVERSITY
Practice Address - Street 2:200 NORTH WOLFE STRRET, # 1058
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR066260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR066260OtherNURSE LICENSE #
MDKR4705QQMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
MDR066260OtherNURSE LICENSE #