Healthcare Provider Details

I. General information

NPI: 1487651022
Provider Name (Legal Business Name): KATHLEEN MICHAELS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 SAINT PAUL ST
BALTIMORE MD
21218-4312
US

IV. Provider business mailing address

2803 SAINT PAUL ST
BALTIMORE MD
21218-4312
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5209
  • Fax: 410-467-3706
Mailing address:
  • Phone: 410-467-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR092209
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: