Healthcare Provider Details

I. General information

NPI: 1992219885
Provider Name (Legal Business Name): JOSIE DANTZLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 YORK RD
BALTIMORE MD
21212-4225
US

IV. Provider business mailing address

5209 YORK RD
BALTIMORE MD
21212-4225
US

V. Phone/Fax

Practice location:
  • Phone: 410-417-5297
  • Fax: 410-510-1375
Mailing address:
  • Phone: 410-417-5297
  • Fax: 410-510-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberR150037
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR150037
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: