Provider Demographics
NPI:1750596193
Name:THANEY, KATHLEEN MARGARET (CRNP-A)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:THANEY
Suffix:
Gender:F
Credentials:CRNP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 N COLLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1630
Mailing Address - Country:US
Mailing Address - Phone:410-675-3911
Mailing Address - Fax:
Practice Address - Street 1:401 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1003
Practice Address - Country:US
Practice Address - Phone:410-955-3250
Practice Address - Fax:410-614-3643
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR083718363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR083718OtherNURSING LICENSE
MDS52284Medicare UPIN
MDS732S52284Medicare ID - Type Unspecified