Provider Demographics
NPI:1538151345
Name:ANDREWS, MARILYN BOCHENKO (MS, CANP)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:BOCHENKO
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MS, CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10085 RED RUN BLVD, SUITE 306
Mailing Address - Street 2:GBMC AT OWINGS MILLS
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-581-7804
Mailing Address - Fax:410-356-6507
Practice Address - Street 1:10085 RED RUN BLVD, SUITE 306
Practice Address - Street 2:GBMC AT OWINGS MILLS
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-581-7804
Practice Address - Fax:410-356-6507
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079286363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD434228300Medicaid
MD434228300Medicaid
KK08D349Medicare ID - Type Unspecified