Healthcare Provider Details

I. General information

NPI: 1245308675
Provider Name (Legal Business Name): CAROL ANN OFFUTT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAISER PERMANENTE 2100 W PENNSYLVANIA AVE
WASHINGTON DC
20037-4236
US

IV. Provider business mailing address

KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 202-872-7000
  • Fax: 202-872-7286
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024142059
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001142059
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN62819
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: