Provider Demographics
NPI:1679824924
Name:DURKEE, MANISHA GONSALVES (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MANISHA
Middle Name:GONSALVES
Last Name:DURKEE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MANISHA
Other - Middle Name:
Other - Last Name:GONSALVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:7501 SURRATTS RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3362
Mailing Address - Country:US
Mailing Address - Phone:301-877-7353
Mailing Address - Fax:301-877-5637
Practice Address - Street 1:7501 SURRATTS RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-877-7353
Practice Address - Fax:301-877-5637
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17027363LF0000X
DCRN1038868363LF0000X
MDAC001603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily