Healthcare Provider Details

I. General information

NPI: 1780633685
Provider Name (Legal Business Name): KATHLEEN M MENTEN M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
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 64474
BALTIMORE MD
21264-4474
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8964
  • Fax:
Mailing address:
  • Phone: 410-933-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: