Healthcare Provider Details

I. General information

NPI: 1942712559
Provider Name (Legal Business Name): CAROLINE EKEY FNP-CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 BEDFORD AVE STE 113
PIKESVILLE MD
21208
US

IV. Provider business mailing address

8028 RITCHIE HWY STE 210B
PASADENA MD
21122-1059
US

V. Phone/Fax

Practice location:
  • Phone: 480-878-7806
  • Fax: 443-732-0054
Mailing address:
  • Phone: 443-416-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR150254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: