Healthcare Provider Details

I. General information

NPI: 1386677854
Provider Name (Legal Business Name): KELLY M. RECHTIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY M. PIERLE

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST JOHNS HOPKINS HOSPITAL
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64382
BALTIMORE MD
21264-4382
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-2762
  • Fax:
Mailing address:
  • Phone: 410-550-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166871
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28151920A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR187508
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: