Healthcare Provider Details

I. General information

NPI: 1407498256
Provider Name (Legal Business Name): SILVIA VALENCIA HAZEL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 OLD COLUMBIA RD STE P170
COLUMBIA MD
21046-1727
US

IV. Provider business mailing address

17748 CHIPPING CT
OLNEY MD
20832-1625
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-5280
  • Fax:
Mailing address:
  • Phone: 301-502-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR210282
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: