Healthcare Provider Details

I. General information

NPI: 1306219688
Provider Name (Legal Business Name): CAROLINE MURRAY CANNON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE CANNON WISEMAN NP-C

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9905 MEDICAL CENTER DR STE 200
ROCKVILLE MD
20850-6535
US

IV. Provider business mailing address

9905 MEDICAL CENTER DR STE 200
ROCKVILLE MD
20850-6535
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-6231
  • Fax: 301-294-4648
Mailing address:
  • Phone: 301-424-6231
  • Fax: 301-294-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN1016495
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1016495
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: