MEDICARE: MS. KAREN KRENITSKY PHINNEY APRNC

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	R094871	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	291609	OTHER	MD	MAMSI

General Provider Information

NPI Number	:	1548268832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN KRENITSKY PHINNEY APRNC

Provider Business Mailing Address
First Line	:	8915 SHADY GROVE CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1308
Country	:	US
Telephone Number	:	301-963-0060
Fax Number	:	301-258-7482

Provider Business Practice Location Address
First Line	:	8915 SHADY GROVE CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1308
Country	:	US
Telephone Number	:	301-963-0060
Fax Number	:	301-258-7482

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/16/2009

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