Healthcare Provider Details

I. General information

NPI: 1366909699
Provider Name (Legal Business Name): DANIELLE OTT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE GOEREN CRNA

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UPPER CHESAPEAKE DR
BEL AIR MD
21014-4324
US

IV. Provider business mailing address

2330 FLEET ST
BALTIMORE MD
21224-3624
US

V. Phone/Fax

Practice location:
  • Phone: 443-643-1000
  • Fax:
Mailing address:
  • Phone: 516-312-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number676976
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number676976-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: