Healthcare Provider Details

I. General information

NPI: 1053863696
Provider Name (Legal Business Name): MEGAN ELIZABETH WATERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST BLALOCK 1410
BALTIMORE MD
21287
US

IV. Provider business mailing address

600 N WOLFE ST BLALOCK 1410
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 443-287-2937
  • Fax: 410-955-8309
Mailing address:
  • Phone: 443-287-2937
  • Fax: 410-955-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR225765
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: