Healthcare Provider Details

I. General information

NPI: 1861451734
Provider Name (Legal Business Name): MAUREEN ROCHELLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SEAMON AVE
BALTIMORE MD
21225-1117
US

IV. Provider business mailing address

3938 WHITE ROSE WAY
ELLICOTT CITY MD
21042-5822
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-8048
  • Fax: 410-396-8052
Mailing address:
  • Phone: 410-750-7734
  • Fax: 410-461-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRO56461
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: