1245395540 NPI number — MS. PRISCILLA ELLEN HOPKINS QUACKENBUSH RN,BSN,MSN,MSEL,FNP

Table of content: MS. PRISCILLA ELLEN HOPKINS QUACKENBUSH RN,BSN,MSN,MSEL,FNP (NPI 1245395540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245395540 NPI number — MS. PRISCILLA ELLEN HOPKINS QUACKENBUSH RN,BSN,MSN,MSEL,FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUACKENBUSH
Provider First Name:
PRISCILLA
Provider Middle Name:
ELLEN HOPKINS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN,BSN,MSN,MSEL,FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOPKINS
Provider Other First Name:
PRISCILLA
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN,BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245395540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13404 BONNIE DALE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-519-8729
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WALTER REED ARMY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
6900 GEORGIA AVE NW
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-782-1666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

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: 171000000X , with the licence number:  165369 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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