Provider Demographics
NPI:1578868964
Name:DEMETRICIAN, NANCY ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANNETTE
Last Name:DEMETRICIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:KIMBROUGH AMBULATORY CARE CENTER
Mailing Address - City:FORT GEORGE G. MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5800
Mailing Address - Country:US
Mailing Address - Phone:301-677-8060
Mailing Address - Fax:301-677-8080
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-7081
Practice Address - Country:US
Practice Address - Phone:301-677-8060
Practice Address - Fax:301-677-8080
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 231662163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDVAD0000Medicare UPIN