Provider Demographics
NPI:1982774600
Name:JAISSLE, LAURA RACHEL (CRNP-PMH)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:RACHEL
Last Name:JAISSLE
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CLIPPING TREE LN.
Mailing Address - Street 2:COCKEYSVILLE
Mailing Address - City:BALTIMORE COUNTY
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:443-621-0478
Mailing Address - Fax:
Practice Address - Street 1:7067 COLUMBIA GATEWAY DR
Practice Address - Street 2:SUITE 180
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046
Practice Address - Country:US
Practice Address - Phone:410-929-7225
Practice Address - Fax:443-333-5434
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR14933363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health