Healthcare Provider Details

I. General information

NPI: 1689740896
Provider Name (Legal Business Name): DONNA A PENCE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E JEFFERSON ST
ROCKVILLE MD
20853
US

IV. Provider business mailing address

KAISER PERMANENTE MID ATLANTIC PERMANENTE MED GRP PC 2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-816-2414
  • Fax: 301-388-1740
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 Number0001042360
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024042360
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: