Healthcare Provider Details

I. General information

NPI: 1497039309
Provider Name (Legal Business Name): MARY ANN CARMODY RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 NEVADA AVE NW
WASHINGTON DC
20015-2470
US

IV. Provider business mailing address

6121 NEVADA AVE NW
WASHINGTON DC
20015-2470
US

V. Phone/Fax

Practice location:
  • Phone: 202-364-5303
  • Fax:
Mailing address:
  • Phone: 202-364-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001135633
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR092051
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN23030
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: