Organization
JACQUELINE G. HANCOCK, CRNA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE KGWEN HANCOCK CRNA (CRNA)
(410) 239-7074
Entity
Organization
Contact information
Practice address
3245 FARM LN, MANCHESTER, MD 21102-1780
(410) 893-1172
Mailing address
3245 FARM LN, MANCHESTER, MD 21102-1780
(410) 239-7074
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R036423
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050M
MEDICARE GROUP ID
—
05
—
218011100
—
MD
Enumeration date
04/30/2008
Last updated
04/30/2008
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