Healthcare Provider Details

I. General information

NPI: 1104199736
Provider Name (Legal Business Name): ERICA LYNN BURNS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERICA LYNN BROWN CRNA

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CEDAR LN
COLUMBIA MD
21044-2912
US

IV. Provider business mailing address

435 FAIRFORD CT
SEVERNA PARK MD
21146-1636
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-7890
  • Fax:
Mailing address:
  • Phone: 410-493-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR165211
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: