Healthcare Provider Details

I. General information

NPI: 1972505956
Provider Name (Legal Business Name): ARLENE WALDO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE ANESTHESIA DEPARTMENT
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

6701 N CHARLES ST # 4226
TOWSON MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5209
  • Fax:
Mailing address:
  • Phone: 516-626-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR106408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: