Healthcare Provider Details

I. General information

NPI: 1922451046
Provider Name (Legal Business Name): KATARZYNA MARIA FRACZEK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BALTIMORE ST
BALTIMORE MD
21201-1138
US

IV. Provider business mailing address

1709 KENNOWAY RD
PARKVILLE MD
21234-5205
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-8814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR221699
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: