Healthcare Provider Details

I. General information

NPI: 1033497656
Provider Name (Legal Business Name): ANNA JAROMCZYK PRALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2011
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 PRINCE PHILIP DR
OLNEY MD
20832-1514
US

IV. Provider business mailing address

348 CHESTERTOWN ST
GAITHERSBURG MD
20878-5724
US

V. Phone/Fax

Practice location:
  • Phone: 919-323-6465
  • Fax:
Mailing address:
  • Phone: 919-323-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221791
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR197464
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR197464
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: