Healthcare Provider Details

I. General information

NPI: 1902181043
Provider Name (Legal Business Name): JACQUELYN CURRERI EDENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E LEE ST PEDIATRICS AT THE HARBOR
BALTIMORE MD
21202-6000
US

IV. Provider business mailing address

3 E LEE ST PEDIATRICS AT THE HARBOR
BALTIMORE MD
21202-6000
US

V. Phone/Fax

Practice location:
  • Phone: 443-682-6610
  • Fax:
Mailing address:
  • Phone: 443-682-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR069315
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR069315
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR069315
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: