Healthcare Provider Details

I. General information

NPI: 1699919522
Provider Name (Legal Business Name): VICTORINE ESAKA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST ANESTHESIOLOGY, S11C00
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST ANESTHESIOLOGY, S11C00
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6120
  • Fax:
Mailing address:
  • Phone: 410-328-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC000612
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: