Provider Demographics
NPI:1346285616
Name:CALIMLIM-DECKER, ELIZABETH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:CALIMLIM-DECKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 ENGLISH RUN CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-8849
Mailing Address - Country:US
Mailing Address - Phone:410-472-3121
Mailing Address - Fax:410-472-2524
Practice Address - Street 1:260 GATEWAY DR
Practice Address - Street 2:#20 A
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:410-420-7630
Practice Address - Fax:410-420-7911
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084031367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215861200Medicaid
MD215861200Medicaid
MD1142Medicare ID - Type UnspecifiedMEDICARE #