Provider Demographics
NPI:1700831740
Name:CROSLAND, KIMBERLY A (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:CROSLAND
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 1:3823 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7884
Mailing Address - Country:US
Mailing Address - Phone:301-874-6075
Mailing Address - Fax:301-874-6075
Practice Address - Street 1:3823 KENDALL DR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MD
Practice Address - Zip Code:21704-7884
Practice Address - Country:US
Practice Address - Phone:301-874-6075
Practice Address - Fax:301-874-6075
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168180367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407564100Medicaid
MDS41729Medicare UPIN
MDNN39M402Medicare ID - Type Unspecified