Provider Demographics
NPI:1043502545
Name:REEB, KRISTEN JOHNSON (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JOHNSON
Last Name:REEB
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 RAMBLING RIDGE LN
Mailing Address - Street 2:#102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1138
Mailing Address - Country:US
Mailing Address - Phone:443-904-3620
Mailing Address - Fax:
Practice Address - Street 1:401 NORTH BROADWAY
Practice Address - Street 2:SUITE 2100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231
Practice Address - Country:US
Practice Address - Phone:410-955-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169252363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care