Provider Demographics
NPI:1235147067
Name:CHESTNUTT, BERNADETTE B (CRFNP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:B
Last Name:CHESTNUTT
Suffix:
Gender:F
Credentials:CRFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20830-1170
Mailing Address - Country:US
Mailing Address - Phone:301-774-2991
Mailing Address - Fax:301-260-0738
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 300
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-2991
Practice Address - Fax:301-260-0738
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR081807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD648871400Medicaid
DC00B678D28Medicare ID - Type UnspecifiedMETRO DC MEDICARE NUMBER
MD543MG128Medicare ID - Type UnspecifiedMARYLAND MEDICARE NUMBER
MD543MMedicare PIN
MDP53650Medicare UPIN
DCG01128Medicare PIN