Healthcare Provider Details

I. General information

NPI: 1699771428
Provider Name (Legal Business Name): KRISTA BROWN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S PACA ST
BALTIMORE MD
21201-1771
US

IV. Provider business mailing address

PO BOX 64380
BALTIMORE MD
21264-4380
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6792
  • Fax: 410-328-8726
Mailing address:
  • Phone: 410-328-6792
  • Fax: 410-328-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP008493
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR146338
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: