Healthcare Provider Details

I. General information

NPI: 1942392923
Provider Name (Legal Business Name): MARIE RENE AUSTIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVENUE WALTER REED NATIONAL MILITARY MEDICAL CENTER
BETHESDA MD
20889-2451
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVENUE
BETHESDA MD
20889-7938
US

V. Phone/Fax

Practice location:
  • Phone: 301-367-5914
  • Fax:
Mailing address:
  • Phone: 301-295-0196
  • Fax: 301-319-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR059654
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: