Healthcare Provider Details

I. General information

NPI: 1508131699
Provider Name (Legal Business Name): KRISTEN KOLLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 LOUGHBORO RD NW STE 320
WASHINGTON DC
20016-2626
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-5555
  • Fax: 202-660-6103
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1049137
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: