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General NPI Number Information
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NPI Number | 1174043236
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Entity Type | Individual
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Provider Name | MISHA CAPRI PURNELL CPNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 3450 OLD WASHINGTON RD STE 100
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City | WALDORF
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State | MD
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Zip | 20602-3249
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Country | US
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Telephone | 301-572-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 207 HILL RD
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City | LANDOVER
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State | MD
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Zip | 20785-4838
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Country | US
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Telephone | 301-806-3643
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Fax | 301-806-3643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20170472
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | R214060
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License Number State | MD
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