Provider Demographics
NPI:1992045363
Name:NANCE, GENA DENICE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:GENA
Middle Name:DENICE
Last Name:NANCE
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 1:314 FRANKLIN AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1238
Mailing Address - Country:US
Mailing Address - Phone:410-629-1450
Mailing Address - Fax:410-629-1460
Practice Address - Street 1:314 FRANKLIN AVE STE 304
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1238
Practice Address - Country:US
Practice Address - Phone:410-629-1450
Practice Address - Fax:410-629-1460
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003077363LF0000X
MDR173550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD1992045363Medicaid
MDS118Medicare PIN