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General NPI Number Information
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NPI Number | 1689495491
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Entity Type | Individual
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Provider Name | ANNELISE MELISSA NENTWICK CRNP-PMH
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 325 HOSPITAL DR STE 106
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5806
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Country | US
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Telephone | 443-430-2998
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Fax | 443-431-8978
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Provider Business Mailing Address
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Address Line | 8111 ARROWHEAD CT
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City | FREDERICK
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State | MD
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Zip | 21702-3053
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Country | US
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Telephone | 607-227-0872
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R239351
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License Number State | MD
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