Provider Demographics
NPI:1770022105
Name:FEJKA, ANNE MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:FEJKA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 GROSVENOR PL APT 219
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4670
Mailing Address - Country:US
Mailing Address - Phone:240-678-4955
Mailing Address - Fax:
Practice Address - Street 1:9000 ROCKVILLE PIKE BLDG 10
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-4670
Practice Address - Country:US
Practice Address - Phone:240-678-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182266363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics