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General NPI Number Information
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NPI Number | 1346506979
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Entity Type | Organization
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Legal Business Name | CRISFIELD CLINIC LLC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 4384 CRISFIELD HWY
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City | CRISFIELD
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State | MD
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Zip | 21817-2550
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Country | US
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Telephone | 410-968-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 4384 CRISFIELD HWY
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City | CRISFIELD
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State | MD
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Zip | 21817-2550
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Country | US
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Telephone | 410-968-1800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KERRY COLLEEN PALAKANIS
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Credential | CRNP
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Telephone | 443-493-0062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | R091871
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R105366
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License Number State | MD
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