MEDICARE: PROF. JANE FAITH KAPUSTIN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	R076707	MD

General Provider Information

NPI Number	:	1114921681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JANE FAITH KAPUSTIN CRNP

Provider Business Mailing Address
First Line	:	5319 FIVE FINGERS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2316
Country	:	US
Telephone Number	:	410-992-4484
Fax Number	:	410-706-0344

Provider Business Practice Location Address
First Line	:	5005 SIGNAL BELL CT
Second Line	:	STE 102
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-2607
Country	:	US
Telephone Number	:	410-531-7557
Fax Number	:	410-531-0818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	07/08/2007

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