Collaboration Agreement No:
9195
Confirmation No:
9195_4570C0004197
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Urgent Care
Facility
U.N.I. Urgent Care Center at Washington Road
Address
826 Washington Road, Ste 110A
Westminster
MD 21157
Is this the location where a copy of your collaboration agreement is on file? YES
A copy (paper or electronic) must be immediately available upon request by the Board.
Section 3 - Advanced Duties and Prescriptive and Dispensing Authority
1.Does this Collaboration Agreement include Advanced Duties?
NO
2. Does this Collaboration Agreement include prescriptive authority?
NO
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
NO