Healthcare Provider Details

I. General information

NPI: 1386736239
Provider Name (Legal Business Name): JOAN MARIE MISENCIK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CTR 50 IRVING ST N.W.
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

10802 TOPBRANCH LN
COLUMBIA MD
21044-3692
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone: 410-740-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License NumberE41975
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: