Individual
MRS. KELLY J VASQUENZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
600 N WOLFE STREET, BLALOCK 904, BALTIMORE, MD 21287-0005
(410) 614-6222
Mailing address
P.O. BOX 64382, BALTIMORE, MD 21264-4382
(410) 933-5474
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
R127273
MD
363LP0200X
Pediatric Nurse Practitioner
20010086
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
R127273
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T0910
JHH
—
Enumeration date
11/16/2007
Last updated
04/29/2011
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