Provider Demographics
NPI:1053396986
Name:BOUSHEHRI, KRISTINA I (CNM)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:I
Last Name:BOUSHEHRI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 MAPLE LAWN BLVD
Mailing Address - Street 2:STE 1 LOWER LOBBY
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2565
Mailing Address - Country:US
Mailing Address - Phone:410-531-7557
Mailing Address - Fax:410-531-0818
Practice Address - Street 1:7625 MAPLE LAWN BLVD
Practice Address - Street 2:STE 1 LOWER LOBBY
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:410-531-7557
Practice Address - Fax:410-531-0818
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133237176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife