Healthcare Provider Details

I. General information

NPI: 1760233738
Provider Name (Legal Business Name): BRIDGET QUERAL MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9512 HARFORD RD STE 201
BALTIMORE MD
21234-3125
US

IV. Provider business mailing address

9512 HARFORD RD STE 201
BALTIMORE MD
21234-3125
US

V. Phone/Fax

Practice location:
  • Phone: 667-310-2286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383605
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR264318
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR264318
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number741136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: