Provider Demographics
NPI:1932929551
Name:RODNEY, KENNICE ELISA (CRNP)
Entity type:Individual
Prefix:
First Name:KENNICE
Middle Name:ELISA
Last Name:RODNEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6024
Mailing Address - Country:US
Mailing Address - Phone:561-452-3027
Mailing Address - Fax:
Practice Address - Street 1:2 FOXWOOD CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6024
Practice Address - Country:US
Practice Address - Phone:561-452-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR262872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner