Healthcare Provider Details

I. General information

NPI: 1053620971
Provider Name (Legal Business Name): CAROL LISHA WHITTINGTON-WASHINGTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 LANDOVER RD SUITE H
CHEVERLY MD
20785-1443
US

IV. Provider business mailing address

6490 LANDOVER RD SUITE H
CHEVERLY MD
20785-1443
US

V. Phone/Fax

Practice location:
  • Phone: 301-322-1696
  • Fax: 301-322-9122
Mailing address:
  • Phone: 301-322-1696
  • Fax: 301-322-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR094051
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: