Healthcare Provider Details

I. General information

NPI: 1245302652
Provider Name (Legal Business Name): KATHARINE AMY PICCOLI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE AMY WINEBRENNER CRNP

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK ROAD SUITE 301
LUTHERVILLE MD
21093-6022
US

IV. Provider business mailing address

1447 YORK RD SUITE 301
LUTHERVILLE MD
21093-6017
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-9090
  • Fax: 410-494-7064
Mailing address:
  • Phone: 410-252-9090
  • Fax: 410-494-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR149558
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: