Healthcare Provider Details

I. General information

NPI: 1710433693
Provider Name (Legal Business Name): JANE KUTSUSHI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 POST OFFICE RD UNIT 4A9497
WALDORF MD
20602-2726
US

IV. Provider business mailing address

9497 PEP RALLY LN
WALDORF MD
20603-3898
US

V. Phone/Fax

Practice location:
  • Phone: 202-489-6118
  • Fax:
Mailing address:
  • Phone: 202-489-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1006184
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1006184
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1006184
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR166622
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN1006184
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN1006184
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberNP1006184
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: