Healthcare Provider Details

I. General information

NPI: 1114926326
Provider Name (Legal Business Name): ANNE LOUISE DENICOFF CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ANNE LOUISE BERGER

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 SHADY GROVE RD #304
ROCKVILLE MD
20850-3254
US

IV. Provider business mailing address

15225 SHADY GROVE RD #304
ROCKVILLE MD
20850-3254
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-0660
  • Fax: 301-330-7583
Mailing address:
  • Phone: 301-840-0660
  • Fax: 301-330-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR096806
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: