Healthcare Provider Details

I. General information

NPI: 1760635411
Provider Name (Legal Business Name): JACKELIN ESTHER CURRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16900 SCIENCE DR SUITE 100
BOWIE MD
20715-4401
US

IV. Provider business mailing address

15311 GLASTONBURY WAY
UPPER MARLBORO MD
20774-8065
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-7008
  • Fax: 301-881-2449
Mailing address:
  • Phone: 410-744-5133
  • Fax: 410-788-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR142306
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: