Provider Demographics
NPI:1922144716
Name:HOUCK, JANE M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:HOUCK
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:JOHNS HOPINS SCHOOL OF MEDICINE
Mailing Address - Street 2:CARNEGIE 346 600 NORTH WOLFE ST
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:410-905-9704
Mailing Address - Fax:410-955-7889
Practice Address - Street 1:600 NORTH WOLFE ST
Practice Address - Street 2:CARNEGIE 346
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-614-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO69582363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329900700Medicaid
MDPO1548Medicare UPIN