Healthcare Provider Details

I. General information

NPI: 1700167053
Provider Name (Legal Business Name): CAROL ANN KUGLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL ANN GERDON RN

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GOLD MINE RD
BROOKEVILLE MD
20833-2238
US

IV. Provider business mailing address

PO BOX 5267
LAUREL MD
20726-5267
US

V. Phone/Fax

Practice location:
  • Phone: 301-908-4723
  • Fax: 301-490-3929
Mailing address:
  • Phone: 301-470-3639
  • Fax: 301-490-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberR101865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: