Healthcare Provider Details

I. General information

NPI: 1609928373
Provider Name (Legal Business Name): SUSAN MALECKI RENDA CRNP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST 2ND FLOOR
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

601 N CAROLINE ST 2ND FLOOR
BALTIMORE MD
21287-0006
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-7140
  • Fax: 410-614-9586
Mailing address:
  • Phone: 410-955-7140
  • Fax: 410-614-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR085470
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: