Western Maryland Pediatrics

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

Legal business name

WESTERN MARYLAND PEDIATRICS

Practice address

13308 Winchester Road
Lavale, MD 21502

Phone

(301) 707-7270

NPI assigned

Nov 13, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacquelyn Petrella Bauer, CRNP

Title

Neonatal, Pediatric Nurse Practiti

Phone

(301) 707-7270

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1265256531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13210 GROWDENVALE DRIVE NE",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "21502",
            "telephone_number": "301-707-7270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13308 WINCHESTER ROAD",
            "city": "LAVALE",
            "state": "MD",
            "postal_code": "21502",
            "telephone_number": "301-707-7270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MARYLAND PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-13",
        "last_updated": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "PETRELLA",
        "authorized_official_title_or_position": "NEONATAL, PEDIATRIC NURSE PRACTITI",
        "authorized_official_telephone_number": "301-707-7270",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP (Walmart Pharmacy 10-2027)
• Wal-Mart Stores East, LP (Vision Center 30-2027)
• Samantha Wampler, CRNP
• Wellcare Inc
• Western Maryland Medical Supply
• Western Maryland Vision Associates (sterling optical)
• Austin Kenneth White, CCC-SLP
• Arthur W. Willison, MA, LCPC
• Denise V Wilson, CRNP
• John O. Wolfe II, DDS

• Pediatric Nurse Practitioner in Lavale, MD
• Providers in Lavale, MD by specialty
• Pediatric Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.