Provider Demographics
NPI:1912147984
Name:DORNBUSCH, JOHN TERRENCE (CRNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TERRENCE
Last Name:DORNBUSCH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 GRALAN RD.
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-747-6742
Mailing Address - Fax:410-222-6362
Practice Address - Street 1:7408 COASTAL HWY.
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842
Practice Address - Country:US
Practice Address - Phone:410-524-0075
Practice Address - Fax:410-352-3556
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN076664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner