Healthcare Provider Details

I. General information

NPI: 1326116674
Provider Name (Legal Business Name): DONNA MCCONATHY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 ALBERT RD FL 2
BRANDYWINE MD
20613-3035
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-888-2233
  • Fax: 301-888-9133
Mailing address:
  • Phone: 301-816-2424
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR081651
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: