Kristina I Boushehri, CNM
Individual provider Active NPI Midwife · Fulton, MD
NPI 1053396986 · NPPES record last updated Jul 6, 2011
Key facts
- NPI
- 1053396986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- R133237 (MD)
- Practice address
- 7625 Maple Lawn Blvd
Ste 1 Lower Lobby
Fulton, MD 20759-2565 - Phone
- (410) 531-7557
- Fax
- (410) 531-0818
- NPI assigned
- Dec 14, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R133237 | MD | MD | Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | R133237 | MD | Yes |
Addresses
Primary practice location
7625 Maple Lawn Blvd
Ste 1 Lower Lobby
Fulton, MD 20759-2565
Mailing address
7625 Maple Lawn Blvd
Ste 1 Lower Lobby
Fulton, MD 20759-2565
Phone (410) 531-7557
Other providers in Fulton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.