1053566406 NPI number — MRS. MARTHA DEBORAH ROSE CRNP

Table of content: MRS. MARTHA DEBORAH ROSE CRNP (NPI 1053566406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053566406 NPI number — MRS. MARTHA DEBORAH ROSE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSE
Provider First Name:
MARTHA
Provider Middle Name:
DEBORAH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053566406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20416 BLOOMINGVILLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20876-5648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-540-8647
Provider Business Mailing Address Fax Number:
301-540-8647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 23RD ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-715-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R116317 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN40365 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)