Healthcare Provider Details

I. General information

NPI: 1003813072
Provider Name (Legal Business Name): KIMBERLY LYN ZEREN CRNP- FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 THOMAS JOHNSON DR SUITE 109
FREDERICK MD
21702-4425
US

IV. Provider business mailing address

3100 WYMAN PARK DR
BALTIMORE MD
21211-2803
US

V. Phone/Fax

Practice location:
  • Phone: 301-696-1011
  • Fax: 301-696-1520
Mailing address:
  • Phone: 410-338-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR111875
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: