Organization Name: | CRISFIELD CLINIC LLC |
NPI Number: | 1346506979 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KERRY COLLEEN PALAKANIS (OWNER) |
Mailing Address: | 4384 Crisfield Hwy Crisfield |
State: | MD US |
Postal Code: | 218172550 |
Phone Number: | 4109681800 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2012 |
NPI Last Update Date: | 04/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LX0001X |
License Number: | R091871 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Obstetrics & Gynecology |
Taxonomy Definition: |