Healthcare Provider Details

I. General information

NPI: 1104392513
Provider Name (Legal Business Name): ANJU LIZ JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 11/05/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR STE 503
BETHESDA MD
20817-7822
US

IV. Provider business mailing address

25 CROSSROADS DR STE 306
OWINGS MILLS MD
21117-5437
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1700
  • Fax:
Mailing address:
  • Phone: 410-581-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR202794
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: