Healthcare Provider Details

I. General information

NPI: 1437557337
Provider Name (Legal Business Name): JENNIFER BRUCIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1497
US

IV. Provider business mailing address

722 MARIANNE LN
CATONSVILLE MD
21228-4710
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-2564
  • Fax:
Mailing address:
  • Phone: 410-303-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR121660
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR121660
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: