Provider Demographics
NPI:1104175819
Name:DUSWALT, PATRICIA MARIE (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:DUSWALT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22495 CAMP CALVERT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-4710
Mailing Address - Country:US
Mailing Address - Phone:301-475-8484
Mailing Address - Fax:301-373-6900
Practice Address - Street 1:22590 SHADY CT
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-5009
Practice Address - Country:US
Practice Address - Phone:301-863-7041
Practice Address - Fax:301-863-8927
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR111519176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife