Healthcare Provider Details

I. General information

NPI: 1093064073
Provider Name (Legal Business Name): AMEENA JAIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S NORTH POINT RD
BALTIMORE MD
21224-3338
US

IV. Provider business mailing address

1012 S NORTH POINT RD
BALTIMORE MD
21224-3338
US

V. Phone/Fax

Practice location:
  • Phone: 443-216-4800
  • Fax:
Mailing address:
  • Phone: 443-216-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number764950
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR211311
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: