Healthcare Provider Details

I. General information

NPI: 1811187669
Provider Name (Legal Business Name): CAROLYN WEISS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 HUNGERFORD DR SUITE 39
ROCKVILLE MD
20850-1713
US

IV. Provider business mailing address

PO BOX 8734
SILVER SPRING MD
20907-8734
US

V. Phone/Fax

Practice location:
  • Phone: 301-806-7623
  • Fax:
Mailing address:
  • Phone: 301-806-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR080752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: