Healthcare Provider Details

I. General information

NPI: 1568903235
Provider Name (Legal Business Name): LAURA JOSEPH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MOODY RD
MIDDLE RIVER MD
21220-3885
US

IV. Provider business mailing address

609 MOODY RD
MIDDLE RIVER MD
21220-3885
US

V. Phone/Fax

Practice location:
  • Phone: 443-812-8422
  • Fax:
Mailing address:
  • Phone: 443-812-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR146362
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR146362
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberR146362
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: