MEDICARE: KATHLEEN MICHAELS C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R092209	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	454MF878	OTHER	MD	TRAILBLAZER

General Provider Information

NPI Number	:	1487651022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MICHAELS C.R.N.A.

Provider Business Mailing Address
First Line	:	2803 SAINT PAUL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4312
Country	:	US
Telephone Number	:	410-467-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 SAINT PAUL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4312
Country	:	US
Telephone Number	:	410-601-5209
Fax Number	:	410-467-3706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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