Healthcare Provider Details

I. General information

NPI: 1790157428
Provider Name (Legal Business Name): ABBY WURZEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY GIBBONS RN

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 101
BETHESDA MD
20817-1183
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-2235
  • Fax: 301-530-8164
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-1989
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAC002641
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: