Healthcare Provider Details

I. General information

NPI: 1346597432
Provider Name (Legal Business Name): ASIA KIMBERLY BURRUSS CNA/GNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 RICHWOOD AVE
BALTIMORE MD
21212-4618
US

IV. Provider business mailing address

524 RICHWOOD AVE
BALTIMORE MD
21212-4618
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-0753
  • Fax:
Mailing address:
  • Phone: 410-402-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00125437
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: