Healthcare Provider Details

I. General information

NPI: 1144524018
Provider Name (Legal Business Name): JACQUELINE A SAAD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST
TOWSON MD
21204-6808
US

IV. Provider business mailing address

230 SCHILLING CIRCLE STE 170 ATTN: MARY ELLEN CUTHIE
HUNT VALLEY MD
21031-1417
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-4616
  • Fax: 410-337-5068
Mailing address:
  • Phone: 410-296-4616
  • Fax: 410-337-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1013655
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR170535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: