Provider Demographics
NPI:1114921681
Name:KAPUSTIN, JANE FAITH (CRNP)
Entity Type:Individual
Prefix:PROF
First Name:JANE
Middle Name:FAITH
Last Name:KAPUSTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5319 FIVE FINGERS WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2316
Mailing Address - Country:US
Mailing Address - Phone:410-992-4484
Mailing Address - Fax:410-706-0344
Practice Address - Street 1:5005 SIGNAL BELL CT
Practice Address - Street 2:STE 102
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2607
Practice Address - Country:US
Practice Address - Phone:410-531-7557
Practice Address - Fax:410-531-0818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076707363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health