Healthcare Provider Details

I. General information

NPI: 1588690283
Provider Name (Legal Business Name): MS. JAN M KRIEBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W REDWOOD ST SUITE 500
BALTIMORE MD
21201-1734
US

IV. Provider business mailing address

PO BOX 64551
BALTIMORE MD
21264-4551
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6640
  • Fax: 410-328-2648
Mailing address:
  • Phone: 410-328-0253
  • Fax: 410-328-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR087082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: