Provider Demographics
NPI:1104352269
Name:DONMOYER, BRENT (PMHNP)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:DONMOYER
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 PISSARO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3478
Mailing Address - Country:US
Mailing Address - Phone:301-524-3782
Mailing Address - Fax:
Practice Address - Street 1:301 INSPIRATION LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5817
Practice Address - Country:US
Practice Address - Phone:240-252-3349
Practice Address - Fax:240-477-5265
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR155630363LP0808X
PARN526107L163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health