1558390765 NPI number — JUSTINE PREIS CRNP

Table of content: JUSTINE PREIS CRNP (NPI 1558390765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558390765 NPI number — JUSTINE PREIS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PREIS
Provider First Name:
JUSTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558390765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 MAIDEN CHOICE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-5968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-882-3240
Provider Business Mailing Address Fax Number:
410-661-5093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 WALTHER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-882-3240
Provider Business Practice Location Address Fax Number:
410-661-5093
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R043580 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 093NER-606567-01 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 093NSE-606567-01 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60656701 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8300981 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9676-0027 . This is a "CAREFIRST BCBS OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0943ER-606567-02 . This is a "CAREFIRST BCBS OF MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280003900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0018 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".




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