Healthcare Provider Details

I. General information

NPI: 1477673457
Provider Name (Legal Business Name): MAUREEN MORIARTY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

PO BOX 973
WESTMINSTER MD
21158-0973
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8525
  • Fax: 202-444-2661
Mailing address:
  • Phone: 443-388-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR069826
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: