Healthcare Provider Details

I. General information

NPI: 1205033727
Provider Name (Legal Business Name): JOAN W OXENDINE A-CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10205 BALD HILL ROAD
MITCHELLVILLE MD
20721
US

IV. Provider business mailing address

14000 JERICHO PARK RD CHRISTA MCAULIFFE RESIDENCE HALL, LL
BOWIE MD
20715-3319
US

V. Phone/Fax

Practice location:
  • Phone: 301-860-4177
  • Fax: 301-860-4179
Mailing address:
  • Phone: 301-860-4177
  • Fax: 301-860-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberR062449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: