Healthcare Provider Details

I. General information

NPI: 1992116685
Provider Name (Legal Business Name): ANNA C LAMASA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 ERDMAN AVE
BALTIMORE MD
21213-1720
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4800
  • Fax: 410-675-8947
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 NumberR192621
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: