Provider Demographics
NPI:1053307595
Name:NUGENT, KATHERINE (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2515 BOSTON ST
Mailing Address - Street 2:UNIT P 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4739
Mailing Address - Country:US
Mailing Address - Phone:410-967-7950
Mailing Address - Fax:410-342-2655
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5213
Practice Address - Country:US
Practice Address - Phone:410-646-0331
Practice Address - Fax:410-644-6182
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069863367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD553121704Medicaid
MD171MMedicare ID - Type Unspecified