Healthcare Provider Details

I. General information

NPI: 1003363854
Provider Name (Legal Business Name): KATHRYN KLOSS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E 31ST ST # N200
BALTIMORE MD
21218-3902
US

IV. Provider business mailing address

1 E 31ST ST # N200
BALTIMORE MD
21218-3902
US

V. Phone/Fax

Practice location:
  • Phone: 410-516-8270
  • Fax: 410-516-4784
Mailing address:
  • Phone: 410-516-8270
  • Fax: 410-516-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR201095
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: