Healthcare Provider Details

I. General information

NPI: 1235583162
Provider Name (Legal Business Name): CHEYENNE STACY CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 IRON HORSE LN APT 138
PIKESVILLE MD
21208-2154
US

IV. Provider business mailing address

36 PELLINORE CT
PIKESVILLE MD
21208-1096
US

V. Phone/Fax

Practice location:
  • Phone: 410-598-9638
  • Fax:
Mailing address:
  • Phone: 410-598-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR158738
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: