Healthcare Provider Details

I. General information

NPI: 1073789350
Provider Name (Legal Business Name): MARY F QUINN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY G FLANAGAN CRNP

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 630776
BALTIMORE MD
21263-0776
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5793
  • Fax: 410-328-0248
Mailing address:
  • Phone: 410-328-5793
  • Fax: 410-328-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR069409
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: