Healthcare Provider Details

I. General information

NPI: 1427389774
Provider Name (Legal Business Name): ERNESTINE AUGUSTA KALOKO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 SURRATTS ROAD
CLINTON MD
20735-3395
US

IV. Provider business mailing address

7503 SURRATTS ROAD
CLINTON MD
20735-3395
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-7001
  • Fax: 301-870-6697
Mailing address:
  • Phone: 301-870-7001
  • Fax: 301-870-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR164612
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: