Healthcare Provider Details

I. General information

NPI: 1477544856
Provider Name (Legal Business Name): MARY MICHAEL KLIMT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WEST 40TH STREET ROLAND PARK PLACE
BALTIMORE MD
21211-2134
US

IV. Provider business mailing address

308 W WIND RD
BALTIMORE MD
21204-6740
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-5800
  • Fax: 410-243-5804
Mailing address:
  • Phone: 410-321-0832
  • Fax: 410-296-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR048558
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: