Healthcare Provider Details

I. General information

NPI: 1629379334
Provider Name (Legal Business Name): KRYSTLE STEVENS THOMAS RN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTLE RAE STEVENS RN, CRNA

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE RM 588
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 410-550-0942
  • Fax: 410-550-0443
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number195172
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR193407
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR193407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: