Healthcare Provider Details

I. General information

NPI: 1245277094
Provider Name (Legal Business Name): PATRICIA ANN GRODIN RN,MS,CS,P
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS PATRICIA ANN WORTMAN

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 N LEISURE WORLD BLVD
SILVER SPRING MD
20906-1367
US

IV. Provider business mailing address

1435 BAY HEAD RD
ANNAPOLIS MD
21409-5708
US

V. Phone/Fax

Practice location:
  • Phone: 301-598-1554
  • Fax: 301-598-1569
Mailing address:
  • Phone: 410-349-3456
  • Fax: 410-268-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR063595
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: