Healthcare Provider Details

I. General information

NPI: 1578654018
Provider Name (Legal Business Name): KATHLEEN MARIE HUGHES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KATHLEEN MARIE CISSEL

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HARRY S TRUMAN PKWY
ANNAPOLIS MD
21401-7031
US

IV. Provider business mailing address

9586 WHITE PILLAR TER
GAITHERSBURG MD
20882-2815
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-6625
  • Fax: 410-222-6679
Mailing address:
  • Phone: 301-253-9541
  • Fax: 301-253-9541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR107515
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: