Provider Demographics
NPI:1245308675
Name:OFFUTT, CAROL ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:OFFUTT
Suffix:
Gender:F
Credentials:CRNP
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Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:KAISER PERMANENTE
Practice Address - Street 2:2100 W PENNSYLVANIA AVE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-4236
Practice Address - Country:US
Practice Address - Phone:202-872-7000
Practice Address - Fax:202-872-7286
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024142059363L00000X
VA0001142059363L00000X
DCRN62819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
004681M92Medicare ID - Type Unspecified
S95911Medicare UPIN