Provider Demographics
NPI:1447884366
Name:HARRINGTON-WALL, KATRICE (RN)
Entity type:Individual
Prefix:
First Name:KATRICE
Middle Name:
Last Name:HARRINGTON-WALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 ALLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2520
Mailing Address - Country:US
Mailing Address - Phone:443-928-6766
Mailing Address - Fax:
Practice Address - Street 1:2114 ALLENDALE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2520
Practice Address - Country:US
Practice Address - Phone:443-928-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160175251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health