Healthcare Provider Details

I. General information

NPI: 1770550402
Provider Name (Legal Business Name): JOAN BROWN-SMITH C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR STE 110
COLUMBIA MD
21044-3258
US

IV. Provider business mailing address

PO BOX 841726
DALLAS TX
75284-1726
US

V. Phone/Fax

Practice location:
  • Phone: 410-992-9797
  • Fax: 410-730-0942
Mailing address:
  • Phone: 410-992-9797
  • Fax: 410-730-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR052522
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: