1104985688 NPI number — KATE R FLOWERS C.R.N.P

Table of content: KATE R FLOWERS C.R.N.P (NPI 1104985688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104985688 NPI number — KATE R FLOWERS C.R.N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOWERS
Provider First Name:
KATE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REINHARDT
Provider Other First Name:
KATE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.R.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104985688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 631568
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:
21263-1568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6535 N CHARLES ST
Provider Second Line Business Practice Location Address:
125
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-5826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-849-3779
Provider Business Practice Location Address Fax Number:
443-849-3767
Provider Enumeration Date:
12/08/2006

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: 163W00000X , with the licence number:  R104395 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R104395 , 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: 007578700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: S1270009 . This is a "CAREFIRST REGIONAL GBMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: KJ73GB/88464603 . This is a "CAREFIRST MD GBMC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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