Healthcare Provider Details

I. General information

NPI: 1376679290
Provider Name (Legal Business Name): ANNE MARIE BRANNOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SUMMIT AVENUE
KENSINGTON MD
20895
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2500
  • Fax: 301-897-2333
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN52647
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR096840
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: