Healthcare Provider Details

I. General information

NPI: 1700688728
Provider Name (Legal Business Name): JENNY ECKERT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-5718
  • Fax:
Mailing address:
  • Phone: 410-955-1283
  • Fax: 410-955-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR263005
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: