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NPI Code Detail

MEDICARE: MRS. MARANDA C JACKSON-PARKIN CRNP-BC

MEDICARE: MRS. MARANDA C JACKSON-PARKIN CRNP-BC
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
1364S00000XClinical Nurse SpecialistR168458MD
2363LA2100XAcute Care Nurse PractitionerR168458MD

General Provider Information

NPI Number : 1598903270
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARANDA C JACKSON-PARKIN CRNP-BC
Provider Business Mailing Address
First Line : 100 IRVING STREET
Second Line : MEDSTAR DIABETES INSTITUTE, ROOM 4131
City : WASHINGTON
State : DC
Zip : 20010
Country : US
Telephone Number : 480-703-0248
Fax Number :
Provider Business Practice Location Address
First Line : 901 HARRY S TRUMAN DR N
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20774-5477
Country : US
Telephone Number : 240-677-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2009
Last Update Date : 07/13/2022

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