Healthcare Provider Details

I. General information

NPI: 1396985149
Provider Name (Legal Business Name): COLLEEN B MCCREARY C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

PO BOX 632330
BALTIMORE MD
21263-2330
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-3048
  • Fax:
Mailing address:
  • Phone: 240-566-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR135047
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: