Individual
KANAN DOMINICA LUCY FERNANDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
7600 CARROLL AVE, TAKOMA PARK, MD 20912-6367
(301) 891-7600
Mailing address
13629 PALMETTO CIR, GERMANTOWN, MD 20874-6234
(301) 528-2016
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R164021
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R164021
MARYLAND BOARD OF NURSING- CRNP LICENSE NUMBER
MD
Enumeration date
03/21/2011
Last updated
03/21/2011
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