Healthcare Provider Details

I. General information

NPI: 1609889112
Provider Name (Legal Business Name): BABETTE PENNAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD SUITE 130
ROCKVILLE MD
20850-3222
US

IV. Provider business mailing address

P.O. BOX 10067
GAITHERSBURG MD
20898-9998
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-1650
  • Fax: 301-527-8752
Mailing address:
  • Phone: 301-527-1650
  • Fax: 301-527-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR096053
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: