Provider Demographics
NPI:1245395540
Name:QUACKENBUSH, PRISCILLA ELLEN HOPKINS (RN,BSN,MSN,MSEL,FNP)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:ELLEN HOPKINS
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:RN,BSN,MSN,MSEL,FNP
Other - Prefix:MS
Other - First Name:PRISCILLA
Other - Middle Name:ELLEN
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN
Mailing Address - Street 1:13404 BONNIE DALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-519-8729
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CENTER
Practice Address - Street 2:6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-5000
Practice Address - Country:US
Practice Address - Phone:202-782-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165369171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider