Healthcare Provider Details

I. General information

NPI: 1609360817
Provider Name (Legal Business Name): BONNIE KAHLER RN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BELVEDERE AVENUE
BALTIMORE MD
21215
US

IV. Provider business mailing address

2401 BELVEDERE AVENUE
BALTIMORE MD
21215
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5902
  • Fax: 410-601-5890
Mailing address:
  • Phone: 410-601-5902
  • Fax: 410-601-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR039435
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: