Provider Demographics
NPI:1548268832
Name:PHINNEY, KAREN KRENITSKY (APRNC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:KRENITSKY
Last Name:PHINNEY
Suffix:
Gender:F
Credentials:APRNC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:KRENITSKY
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRNC
Mailing Address - Street 1:8915 SHADY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1308
Mailing Address - Country:US
Mailing Address - Phone:301-963-0060
Mailing Address - Fax:301-258-7482
Practice Address - Street 1:8915 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1308
Practice Address - Country:US
Practice Address - Phone:301-963-0060
Practice Address - Fax:301-258-7482
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR094871364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD291609OtherMAMSI