Healthcare Provider Details

I. General information

NPI: 1750264909
Provider Name (Legal Business Name): VIGILANT VIBE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 BELLONA AVE
LUTHERVILLE MD
21093-5425
US

IV. Provider business mailing address

2296 HOWLAND DR
FOREST HILL MD
21050-2556
US

V. Phone/Fax

Practice location:
  • Phone: 443-686-2236
  • Fax:
Mailing address:
  • Phone: 443-686-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGELIQUE GALEN BROOKS
Title or Position: PRESIDENT
Credential:
Phone: 443-686-2236