Healthcare Provider Details

I. General information

NPI: 1053307595
Provider Name (Legal Business Name): KATHERINE NUGENT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE SUITE 100
BALTIMORE MD
21229-5213
US

IV. Provider business mailing address

2515 BOSTON ST UNIT P 1
BALTIMORE MD
21224-4739
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-0331
  • Fax: 410-644-6182
Mailing address:
  • Phone: 410-967-7950
  • Fax: 410-342-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR069863
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: