Basic Information
| Provider Information | |||||||||
| NPI: | 1013908045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRBY | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 GOLDSBORO RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208175846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012630800 | ||||||||
| FaxNumber: | 3012630820 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 GOLDSBORO RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208175846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012630800 | ||||||||
| FaxNumber: | 3012630820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R128176 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 905201100 | 05 | MD | MEDICAID | KBC1CH | 01 | MD | CAREFIRST BCBS | OTHER | 430072670 | 01 | MD | RR MEDICARE | OTHER | S417-0013 | 01 | DC | CAREFIRST BCBS | OTHER |