Healthcare Provider Details

I. General information

NPI: 1578965943
Provider Name (Legal Business Name): ANA REBECCA EHRENSPECK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA REBECCA SOULE CRNP

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 CAMPBELL BLVD STE H
BALTIMORE MD
21236-5974
US

IV. Provider business mailing address

6201 GREENLEIGH AVE FL 2
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-9280
  • Fax:
Mailing address:
  • Phone:
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR186878
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: