Healthcare Provider Details

I. General information

NPI: 1295559821
Provider Name (Legal Business Name): LIINA BRATHWAITE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 BROOKS LN
BALTIMORE MD
21217-4508
US

IV. Provider business mailing address

943 BROOKS LN
BALTIMORE MD
21217-4508
US

V. Phone/Fax

Practice location:
  • Phone: 443-939-9172
  • Fax:
Mailing address:
  • Phone: 443-939-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR237540
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: