Provider Demographics
NPI:1164997789
Name:DEGUZMAN, WINNIE KYAW (AGNP)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:KYAW
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6247 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3906
Mailing Address - Country:US
Mailing Address - Phone:301-468-1001
Mailing Address - Fax:301-468-1101
Practice Address - Street 1:3202 TOWER OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4219
Practice Address - Country:US
Practice Address - Phone:301-468-1001
Practice Address - Fax:301-468-1101
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner