Healthcare Provider Details

I. General information

NPI: 1497420129
Provider Name (Legal Business Name): NOUNGUIM VIRGINIA CALDERON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 OLD DOBBIN LN STE 200
COLUMBIA MD
21045-5813
US

IV. Provider business mailing address

6220 OLD DOBBIN LN STE 200
COLUMBIA MD
21045-5813
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-5300
  • Fax:
Mailing address:
  • Phone: 410-964-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR187414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: