Healthcare Provider Details

I. General information

NPI: 1922057066
Provider Name (Legal Business Name): KIMBERLY MCILTROT C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64563
BALTIMORE MD
21264-4563
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9444
  • Fax:
Mailing address:
  • Phone: 410-933-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberARNP9453359
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR115446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: