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General NPI Number Information
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NPI Number | 1972498335
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Entity Type | Individual
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Provider Name | JESSICA KATHLEEN BALTHAZAR RN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 655 W LOMBARD ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1512
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Country | US
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Telephone | 410-706-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 FAIRFAX DR UNIT 1300
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City | ARLINGTON
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State | VA
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Zip | 22203-1687
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Country | US
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Telephone | 631-617-7371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 0001316237
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License Number State | VA
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