Provider Demographics
NPI:1871135681
Name:SWEENEY, CARISSA EMILY (CRNP)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:EMILY
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:EMILY
Other - Last Name:DEFILIPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:301-542-4460
Mailing Address - Fax:
Practice Address - Street 1:8600 LASALLE ROAD
Practice Address - Street 2:SUITE 250B
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:443-279-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR220072OtherCRNP