Healthcare Provider Details

I. General information

NPI: 1639320302
Provider Name (Legal Business Name): TERI ANN MURTHA PMHNP, CNS- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 KENILWORTH DR SUITE 206
TOWSON MD
21204-2312
US

IV. Provider business mailing address

658 KENILWORTH DR SUITE 206
TOWSON MD
21204-2312
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-9311
  • Fax:
Mailing address:
  • Phone: 410-321-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR114531
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR114531
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: