Healthcare Provider Details

I. General information

NPI: 1790740082
Provider Name (Legal Business Name): AMY M SWANK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY M ROSPORSKI CRNA

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS STREET BLALOCK 1410
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 443-287-2937
  • Fax: 410-955-8309
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR150772
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: