Healthcare Provider Details

I. General information

NPI: 1386111763
Provider Name (Legal Business Name): ERIN KENAWELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRANDERMILL BLVD STE 250
GAMBRILLS MD
21054-1668
US

IV. Provider business mailing address

2401 BRANDERMILL BLVD STE 250
GAMBRILLS MD
21054-1668
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-1507
  • Fax: 410-721-1510
Mailing address:
  • Phone: 410-721-1507
  • Fax: 410-721-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208025
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: