Healthcare Provider Details

I. General information

NPI: 1669986493
Provider Name (Legal Business Name): GREGORY DUKES CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S TALBOT ST STE 4
ST MICHAELS MD
21663-2605
US

IV. Provider business mailing address

933 S TALBOT ST STE 4
ST MICHAELS MD
21663-2605
US

V. Phone/Fax

Practice location:
  • Phone: 410-745-0200
  • Fax: 833-908-2281
Mailing address:
  • Phone: 410-745-0200
  • Fax: 339-082-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR114544
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR114544
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: