Healthcare Provider Details

I. General information

NPI: 1134665227
Provider Name (Legal Business Name): ELIZABETH CARRIER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

IV. Provider business mailing address

7490 NEW TECHNOLOGY WAY
FREDERICK MD
21703-8370
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-8713
  • Fax:
Mailing address:
  • Phone: 240-566-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR219599
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: