Healthcare Provider Details

I. General information

NPI: 1447648332
Provider Name (Legal Business Name): LAURA ZIMMERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

8623 GOLDEN GRAIN CT
ELLICOTT CITY MD
21043-6541
US

V. Phone/Fax

Practice location:
  • Phone: 252-202-3747
  • Fax:
Mailing address:
  • Phone: 252-202-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR214374
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: