Healthcare Provider Details

I. General information

NPI: 1760911853
Provider Name (Legal Business Name): PROMISE A OLOMO DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11085 LITTLE PATUXENT PKWY BLDG 4
COLUMBIA MD
21044-2983
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-0099
  • Fax: 410-964-1345
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR186662
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: