Provider Demographics
NPI:1972047389
Name:PALAKUNNEL, ANCY C (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANCY
Middle Name:C
Last Name:PALAKUNNEL
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 1:15245 SHADY GROVE RD
Mailing Address - Street 2:SUITE 130, NORTH LOBBY
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:301-527-1650
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:SUITE 130, NORTH LOBBY
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-527-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208316363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health