Healthcare Provider Details

I. General information

NPI: 1467519017
Provider Name (Legal Business Name): SANDRA LEE MEREDITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

165 BRIGHTWATER DR
ANNAPOLIS MD
21401-4556
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0395
  • Fax:
Mailing address:
  • Phone: 410-267-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR085129
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: