Healthcare Provider Details

I. General information

NPI: 1417986365
Provider Name (Legal Business Name): BETH L. EMAMI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 N CHARLES ST STE 307
BALTIMORE MD
21204-5816
US

IV. Provider business mailing address

14149 LINE RD
NEW FREEDOM PA
17349-9102
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2767
  • Fax:
Mailing address:
  • Phone: 717-235-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP008709
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: