Healthcare Provider Details

I. General information

NPI: 1609268143
Provider Name (Legal Business Name): GRACE YOUNGOK CHO BREWER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YOUNGOK CHO CRNA

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

501 SAINT PAUL ST
BALTIMORE MD
21202-2270
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-1675
  • Fax: 410-955-8309
Mailing address:
  • Phone: 813-841-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6058
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number106049
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: