Provider Demographics
NPI:1639525108
Name:DRUCIS, KIM (CRNP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DRUCIS
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 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-1340
Mailing Address - Fax:
Practice Address - Street 1:401 N BROADWAY ST
Practice Address - Street 2:ROOM 1341
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0019
Practice Address - Country:US
Practice Address - Phone:410-502-0712
Practice Address - Fax:410-614-6466
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR140888363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics