Provider Demographics
NPI:1326047630
Name:WIENHOFF, ROSE M (CRNP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:WIENHOFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:MCCUTCHEON (RAFEEW)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 SOLAREX CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8624
Practice Address - Country:US
Practice Address - Phone:301-682-5500
Practice Address - Fax:301-663-8557
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR073681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD926580505Medicaid
MDCD8143Medicare PIN
MD451LMedicare PIN
MD926580505Medicaid