Provider Demographics
NPI:1447805098
Name:LACSON, MARIA L (CRNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:LACSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARIA LOIDA
Other - Middle Name:DELACRUZ
Other - Last Name:LACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:910 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4516
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:410-646-3623
Practice Address - Street 1:910 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4516
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:410-646-3623
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR156462363L00000X
MDR156462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDL-250-585-537-830OtherMD DRIVERS LICENSE