Provider Demographics
NPI:1215407606
Name:MINES, AHMAD (CRNP)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:MINES
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 MORAY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4242
Mailing Address - Country:US
Mailing Address - Phone:202-495-8320
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S STE 408
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6437
Practice Address - Country:US
Practice Address - Phone:410-424-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily