Healthcare Provider Details

I. General information

NPI: 1326330457
Provider Name (Legal Business Name): SCARLET FANNIN PMHNP-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2011
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W PATRICK ST
FREDERICK MD
21701-4855
US

IV. Provider business mailing address

319 W PATRICK ST
FREDERICK MD
21701-4855
US

V. Phone/Fax

Practice location:
  • Phone: 240-888-9642
  • Fax:
Mailing address:
  • Phone: 240-888-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR193502
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR193502
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: