Healthcare Provider Details

I. General information

NPI: 1619487667
Provider Name (Legal Business Name): NANCY ELIZABETH BRUTSCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 16TH ST STE 202
SILVER SPRING MD
20910-2802
US

IV. Provider business mailing address

3512 FALLING GREEN RD
OLNEY MD
20832-1128
US

V. Phone/Fax

Practice location:
  • Phone: 301-793-8715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR096616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: