Provider Demographics
NPI:1689495491
Name:NENTWICK, ANNELISE MELISSA (CRNP-PMH)
Entity type:Individual
Prefix:DR
First Name:ANNELISE
Middle Name:MELISSA
Last Name:NENTWICK
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 ARROWHEAD CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3053
Mailing Address - Country:US
Mailing Address - Phone:607-227-0872
Mailing Address - Fax:
Practice Address - Street 1:325 HOSPITAL DR STE 106
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5806
Practice Address - Country:US
Practice Address - Phone:443-430-2998
Practice Address - Fax:443-431-8978
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR239351363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health