Healthcare Provider Details

I. General information

NPI: 1881944023
Provider Name (Legal Business Name): EMILY O'CONNELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5838
  • Fax: 410-601-9744
Mailing address:
  • Phone: 410-601-5838
  • Fax: 410-601-9744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR188015
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: