Healthcare Provider Details

I. General information

NPI: 1932929551
Provider Name (Legal Business Name): KENNICE ELISA RODNEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 ANNAPOLIS RD
ODENTON MD
21113-1648
US

IV. Provider business mailing address

10110 MOLECULAR DR STE 101
ROCKVILLE MD
20850-7538
US

V. Phone/Fax

Practice location:
  • Phone: 561-452-3027
  • Fax:
Mailing address:
  • Phone: 301-444-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR262872
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: