Healthcare Provider Details

I. General information

NPI: 1669923017
Provider Name (Legal Business Name): CAITLIN TAWNEY MOYER CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S GREENE ST
BALTIMORE MD
21201-1504
US

IV. Provider business mailing address

29 S GREENE ST
BALTIMORE MD
21201-1504
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5410
  • Fax: 410-328-0652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR185046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: