Provider Demographics
NPI:1396720819
Name:OCASIO, GWENDOLYN RENEE (CRNA)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:RENEE
Last Name:OCASIO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:RENEE
Other - Last Name:MURPHY-OCASIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:3304 DUNWOOD RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1256
Mailing Address - Country:US
Mailing Address - Phone:301-249-2953
Mailing Address - Fax:301-249-2972
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-868-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113203367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered