Healthcare Provider Details

I. General information

NPI: 1942540604
Provider Name (Legal Business Name): CHRISTINE M KELLNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST DEPARTMENT OF ANESTHESIA
TOWSON MD
21204-6808
US

IV. Provider business mailing address

110 WEST RD SUITE 210
TOWSON MD
21204-2316
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 TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR177668
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: