1598903270 NPI number — MRS. MARANDA C JACKSON-PARKIN CRNP-BC

Table of content: MRS. MARANDA C JACKSON-PARKIN CRNP-BC (NPI 1598903270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598903270 NPI number — MRS. MARANDA C JACKSON-PARKIN CRNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON-PARKIN
Provider First Name:
MARANDA
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
MARANDA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598903270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 IRVING STREET
Provider Second Line Business Mailing Address:
MEDSTAR DIABETES INSTITUTE, ROOM 4131
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-703-0248
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 HARRY S TRUMAN DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-5477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-677-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2009

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: 364S00000X , with the licence number:  R168458 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: R168458 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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