Provider Demographics
NPI:1477544856
Name:KLIMT, MARY MICHAEL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHAEL
Last Name:KLIMT
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 1:308 W WIND RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6740
Mailing Address - Country:US
Mailing Address - Phone:410-321-0832
Mailing Address - Fax:410-296-3016
Practice Address - Street 1:830 WEST 40TH STREET
Practice Address - Street 2:ROLAND PARK PLACE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2134
Practice Address - Country:US
Practice Address - Phone:410-243-5800
Practice Address - Fax:410-243-5804
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR048558163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P60956Medicare UPIN