Healthcare Provider Details

I. General information

NPI: 1295712859
Provider Name (Legal Business Name): DONNA MARIE JASON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 SCOTTS LEVEL RD
BALTIMORE MD
21208-2629
US

IV. Provider business mailing address

1850 MC DUFF CT
SYKESVILLE MD
21784-6275
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-3600
  • Fax:
Mailing address:
  • Phone: 410-552-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR113410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: