Healthcare Provider Details

I. General information

NPI: 1992260574
Provider Name (Legal Business Name): WASHINGTON AREA NURSE PRACTITIONER GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE D230
CLINTON MD
20735-1628
US

IV. Provider business mailing address

PO BOX 70861
BETHESDA MD
20813-0861
US

V. Phone/Fax

Practice location:
  • Phone: 202-558-0504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MCDARRY NEWSOME-WILLIAMS
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 301-664-3193