Healthcare Provider Details

I. General information

NPI: 1760568711
Provider Name (Legal Business Name): KATHLEEN A DERR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 PUBLIC LANDING ROAD WORCESTER COUNTY HEALTH DEPARTMENT
SNOW HILL MD
21863
US

IV. Provider business mailing address

PO BOX 249
SNOW HILL MD
21863-0249
US

V. Phone/Fax

Practice location:
  • Phone: 410-632-1100
  • Fax: 410-632-0906
Mailing address:
  • Phone: 410-632-1100
  • Fax: 410-632-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR127350
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: