Healthcare Provider Details

I. General information

NPI: 1184207789
Provider Name (Legal Business Name): KHAJUANNA CARITHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 SNYDER AVE
DUNDALK MD
21222-1713
US

IV. Provider business mailing address

1975 SNYDER AVE
DUNDALK MD
21222-1713
US

V. Phone/Fax

Practice location:
  • Phone: 470-800-1271
  • Fax:
Mailing address:
  • Phone: 470-800-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: