Healthcare Provider Details

I. General information

NPI: 1245013119
Provider Name (Legal Business Name): MRS. MARIE ELISABETH MOUSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PARKWAY DR
HANOVER MD
21076-1388
US

IV. Provider business mailing address

419 UNIVERSITY DR
WALDORF MD
20602-3468
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR198791
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: