Healthcare Provider Details

I. General information

NPI: 1568685824
Provider Name (Legal Business Name): MARIA MULDOON HARBESON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

305 MARTINS COVE RD
ANNAPOLIS MD
21409-5952
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0974
  • Fax:
Mailing address:
  • Phone: 410-757-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR091108
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: