Provider Demographics
NPI:1649385444
Name:CRAIN, ELAINE MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:CRAIN
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 1:31 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2841
Mailing Address - Country:US
Mailing Address - Phone:410-544-5900
Mailing Address - Fax:410-544-5939
Practice Address - Street 1:31 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2841
Practice Address - Country:US
Practice Address - Phone:410-544-5900
Practice Address - Fax:410-544-5939
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124009363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF240 0003OtherBLUE CROSS BLUE SHIELD
MD61911702OtherBLUE CROSS BLUE SHIELD
DCF240 0003OtherBLUE CROSS BLUE SHIELD
MD61911702OtherBLUE CROSS BLUE SHIELD