Provider Demographics
NPI:1508244161
Name:DURU ANOUMATACKY, OBIAGELI (CRNP)
Entity Type:Individual
Prefix:
First Name:OBIAGELI
Middle Name:
Last Name:DURU ANOUMATACKY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:OBIAGELI
Other - Middle Name:
Other - Last Name:LITTLEJOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:9309 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1620
Mailing Address - Country:US
Mailing Address - Phone:301-634-9600
Mailing Address - Fax:301-493-8553
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:301-634-9600
Practice Address - Fax:301-493-8553
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1022296163W00000X
MDR193298163W00000X, 363LF0000X
DC1022296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse