Healthcare Provider Details

I. General information

NPI: 1295048510
Provider Name (Legal Business Name): RACHEL SPAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 W 40TH ST STE LL10
BALTIMORE MD
21211-2112
US

IV. Provider business mailing address

733 W 40TH ST STE LL10
BALTIMORE MD
21211-2112
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-8632
  • Fax: 410-243-0470
Mailing address:
  • Phone: 410-243-8632
  • Fax: 410-243-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR180009
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: