Healthcare Provider Details

I. General information

NPI: 1982901252
Provider Name (Legal Business Name): MRS. JEANNETTE NASHED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CARROLL AVE
TAKOMA PARK MD
20912-6367
US

IV. Provider business mailing address

7600 CARROLL AVE
TAKOMA PARK MD
20912-6367
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-5340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR123524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: