MEDICARE: PATRICIA GLADYS KPOLIE 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	R178625	MD

General Provider Information

NPI Number	:	1780075770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GLADYS KPOLIE CRNP

Provider Business Mailing Address
First Line	:	12355 HERRINGTON MANOR DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1677
Country	:	US
Telephone Number	:	240-755-1924
Fax Number	:

Provider Business Practice Location Address
First Line	:	12355 HERRINGTON MANOR DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1677
Country	:	US
Telephone Number	:	301-593-1315
Fax Number	:	301-681-4699

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

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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