Healthcare Provider Details

I. General information

NPI: 1750766879
Provider Name (Legal Business Name): LAURA GERTZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ORLEANS ST
BALTIMORE MD
21231-1021
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 443-703-3628
  • Fax:
Mailing address:
  • Phone: 410-732-8800
  • Fax: 410-534-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR180687
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: