Provider Demographics
NPI:1629442256
Name:KRETZ, DAWN (DNP, CPNP-PC, IBCLC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KRETZ
Suffix:
Gender:F
Credentials:DNP, CPNP-PC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 GREAT OAK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1854
Mailing Address - Country:US
Mailing Address - Phone:917-822-9031
Mailing Address - Fax:
Practice Address - Street 1:4105 GREAT OAK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-1854
Practice Address - Country:US
Practice Address - Phone:917-822-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167581163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse