Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R170775 | MD |
N | 363LC1500X | Nurse Practitioner - Community Health | R170775 | MD |
NPI | 1033396882 |
---|---|
Provider Name | Ms. Jill Antoinette Crank |
First Address | Baltimore, MD 21236-4902 |
Second Address | Baltimore, MD 21211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 05/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132190100 | (05) | MD |