Healthcare Provider Details

I. General information

NPI: 1811919343
Provider Name (Legal Business Name): JAMIE CHEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

IV. Provider business mailing address

PO BOX 334
SPENCERVILLE MD
20868-0334
US

V. Phone/Fax

Practice location:
  • Phone: 410-793-0791
  • Fax: 410-793-0809
Mailing address:
  • Phone: 301-213-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR167149
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: