Healthcare Provider Details

I. General information

NPI: 1982155164
Provider Name (Legal Business Name): MELODY F NANGLE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2016
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WOODYARD RD SUITE C
CLINTON MD
20735-4264
US

IV. Provider business mailing address

9001 WOODYARD RD STE C
CLINTON MD
20735-4264
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-7333
  • Fax:
Mailing address:
  • Phone: 301-868-7333
  • Fax: 301-868-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR146192
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: