Healthcare Provider Details

I. General information

NPI: 1376546994
Provider Name (Legal Business Name): REGINA KUNDELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 WISCONSIN AVE
BETHESDA MD
20814-3202
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 240-235-9120
  • Fax:
Mailing address:
  • Phone: 301-663-3836
  • Fax: 301-663-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR095408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: