MEDICARE: REGINA KUNDELL CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R095408	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376546994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA KUNDELL CRNP

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	301-663-3836
Fax Number	:	301-663-8062

Provider Business Practice Location Address
First Line	:	7315 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-3202
Country	:	US
Telephone Number	:	240-235-9120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/27/2023

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