Provider Demographics
NPI:1316288699
Name:CAESAR, WANDA C (CRNP-FNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:C
Last Name:CAESAR
Suffix:
Gender:F
Credentials:CRNP-FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2608
Mailing Address - Country:US
Mailing Address - Phone:240-601-0237
Mailing Address - Fax:
Practice Address - Street 1:6700 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20815-5302
Practice Address - Country:US
Practice Address - Phone:301-656-1358
Practice Address - Fax:301-576-4576
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN64224363L00000X
MDR133232363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily