Healthcare Provider Details

I. General information

NPI: 1700597382
Provider Name (Legal Business Name): KRISTEN RENEE ABBOTT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN RENEE HELGESON

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 CATHAGE RD
BERLIN MD
21811-2115
US

IV. Provider business mailing address

25807 GRIST MILL DR
MARDELA SPRINGS MD
21837-2076
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-6104
  • Fax:
Mailing address:
  • Phone: 443-735-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR206046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: