Healthcare Provider Details

I. General information

NPI: 1396720819
Provider Name (Legal Business Name): GWENDOLYN RENEE OCASIO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWENDOLYN RENEE MURPHY-OCASIO CRNA

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 SURRATTS RD
CLINTON MD
20735-3358
US

IV. Provider business mailing address

3304 DUNWOOD RIDGE TER
BOWIE MD
20721-1256
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-8000
  • Fax:
Mailing address:
  • Phone: 301-249-2953
  • Fax: 301-249-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR113203
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: