Healthcare Provider Details

I. General information

NPI: 1689157430
Provider Name (Legal Business Name): JOAN LYTLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR STE 209
BALTIMORE MD
21237-3958
US

IV. Provider business mailing address

3601 WINTERBOURNE DR
UPPER MARLBORO MD
20774-9111
US

V. Phone/Fax

Practice location:
  • Phone: 410-574-1330
  • Fax: 410-574-2691
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR176154
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: