1538506662 NPI number — LINNEA KRISTIN CHESELDINE CRNP

Table of content: LINNEA KRISTIN CHESELDINE CRNP (NPI 1538506662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538506662 NPI number — LINNEA KRISTIN CHESELDINE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHESELDINE
Provider First Name:
LINNEA
Provider Middle Name:
KRISTIN
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:
NELSON
Provider Other First Name:
LINNEA
Provider Other Middle Name:
KRISTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538506662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1589 SULPHUR SPRING RD
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21227-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-536-5400
Provider Business Mailing Address Fax Number:
410-737-2168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CROSSROADS DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-602-7792
Provider Business Practice Location Address Fax Number:
410-602-9889
Provider Enumeration Date:
05/30/2013

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:  R155139 , 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: 298117Y56 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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