Healthcare Provider Details

I. General information

NPI: 1235672205
Provider Name (Legal Business Name): JULIE ANN DAGENHART CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

IV. Provider business mailing address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9688
  • Fax: 301-732-6916
Mailing address:
  • Phone: 240-575-9688
  • Fax: 301-732-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR130377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: