Provider Demographics
NPI:1114926326
Name:DENICOFF, ANNE LOUISE (CPNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:DENICOFF
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:LOUISE
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15225 SHADY GROVE RD
Mailing Address - Street 2:#304
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3254
Mailing Address - Country:US
Mailing Address - Phone:301-840-0660
Mailing Address - Fax:301-330-7583
Practice Address - Street 1:15225 SHADY GROVE RD
Practice Address - Street 2:#304
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3254
Practice Address - Country:US
Practice Address - Phone:301-840-0660
Practice Address - Fax:301-330-7583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR096806363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics