Healthcare Provider Details

I. General information

NPI: 1588053110
Provider Name (Legal Business Name): KATRINA WOLFE ROSS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 BALTIMORE BLVD SUITE A
WESTMINSTER MD
21157-7146
US

IV. Provider business mailing address

1812 BALTIMORE BLVD SUITE A
WESTMINSTER MD
21157-7146
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-6176
  • Fax: 410-857-4176
Mailing address:
  • Phone: 410-751-6176
  • Fax: 410-857-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR161586
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR161586
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: