Provider Demographics
NPI:1275069619
Name:KRETZSCHMAR, MEGAN (MSN, RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:KRETZSCHMAR
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 RACE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2376
Mailing Address - Country:US
Mailing Address - Phone:410-687-0808
Mailing Address - Fax:410-687-0070
Practice Address - Street 1:1232 RACE RD STE 201
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2376
Practice Address - Country:US
Practice Address - Phone:410-687-0808
Practice Address - Fax:410-687-0070
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194144363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics