Healthcare Provider Details

I. General information

NPI: 1417724386
Provider Name (Legal Business Name): KRISTEN LEE LIGUORI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S EUTAW ST FL 1
BALTIMORE MD
21201-1606
US

IV. Provider business mailing address

PO BOX 64226
BALTIMORE MD
21264-4226
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-1718
  • Fax: 410-328-6343
Mailing address:
  • Phone: 667-214-1734
  • Fax: 410-706-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR228306
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: