Healthcare Provider Details

I. General information

NPI: 1639123474
Provider Name (Legal Business Name): KATIE R PAPATHAKIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE R LAMBROS CRNP

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 FRANKLIN SQUARE DR SUITE 1400
BALTIMORE MD
21237-3900
US

IV. Provider business mailing address

9103 FRANKLIN SQUARE DR SUITE 1400
BALTIMORE MD
21237-3900
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7895
  • Fax: 443-777-8027
Mailing address:
  • Phone: 443-777-7895
  • Fax: 443-777-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR149963
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: