Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 045488-23-12 | NH |
NPI | 1033173539 |
---|---|
Provider Name | Mrs. Jacqueline Gannuscio |
First Address | Derwood, MD 20855-2259 |
Second Address | Washington, DC 20422-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 08/07/2007 |