Healthcare Provider Details

I. General information

NPI: 1265823439
Provider Name (Legal Business Name): LEAH KREBS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 LASALLE RD
FOREST HILL MD
21050-2521
US

IV. Provider business mailing address

1606 LASALLE RD
FOREST HILL MD
21050-2521
US

V. Phone/Fax

Practice location:
  • Phone: 443-386-5848
  • Fax:
Mailing address:
  • Phone: 443-386-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR138277
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: