Healthcare Provider Details

I. General information

NPI: 1942562848
Provider Name (Legal Business Name): CONSTANCE MORFAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 FALLS RD
POTOMAC MD
20854-3999
US

IV. Provider business mailing address

9800 FALLS RD
POTOMAC MD
20854-3999
US

V. Phone/Fax

Practice location:
  • Phone: 301-765-9255
  • Fax:
Mailing address:
  • Phone: 301-765-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR180745
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberM-610-122-027-906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: