Healthcare Provider Details

I. General information

NPI: 1730632753
Provider Name (Legal Business Name): CARL E LAGUERRE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8807 BRIARCLIFF LN
FREDERICK MD
21701-5887
US

IV. Provider business mailing address

PO BOX 15
MONROVIA MD
21770-0015
US

V. Phone/Fax

Practice location:
  • Phone: 240-347-2430
  • Fax: 949-695-4189
Mailing address:
  • Phone: 240-347-2430
  • Fax: 949-695-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP016382
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP016382
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR236570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: