Healthcare Provider Details

I. General information

NPI: 1215774922
Provider Name (Legal Business Name): KATHRYN MCCAUSLIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
UNION BRIDGE MD
21791-9102
US

IV. Provider business mailing address

2049 HARVEST FARM RD
ELDERSBURG MD
21784-6399
US

V. Phone/Fax

Practice location:
  • Phone: 443-937-6258
  • Fax:
Mailing address:
  • Phone: 443-547-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR234923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: