Healthcare Provider Details

I. General information

NPI: 1447510375
Provider Name (Legal Business Name): SANDRINE D NOUTCHIA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date: 12/04/2020
Reactivation Date: 01/13/2021

III. Provider practice location address

12261 REVOLUTION CT
WALDORF MD
20602-4226
US

IV. Provider business mailing address

12261 REVOLUTION CT
WALDORF MD
20602-4226
US

V. Phone/Fax

Practice location:
  • Phone: 301-326-6885
  • Fax: 301-888-7514
Mailing address:
  • Phone: 301-326-6885
  • Fax: 301-888-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR203718
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: