Healthcare Provider Details

I. General information

NPI: 1508641713
Provider Name (Legal Business Name): ANNA AVAZHANSKIY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 RUNKLES RD
MOUNT AIRY MD
21771-7319
US

IV. Provider business mailing address

6805 RUNKLES RD
MOUNT AIRY MD
21771-7319
US

V. Phone/Fax

Practice location:
  • Phone: 646-417-0262
  • Fax:
Mailing address:
  • Phone: 646-417-0262
  • Fax: 240-202-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR199222
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR199222
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: