Healthcare Provider Details

I. General information

NPI: 1225016199
Provider Name (Legal Business Name): JUDITH STEVENS MORIARTY CNM, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 W 98TH ST # 134
MINNEAPOLIS MN
55437-2040
US

IV. Provider business mailing address

7421 SKYLINE DR
FREDERICK MD
21702-3651
US

V. Phone/Fax

Practice location:
  • Phone: 612-217-4967
  • Fax: 833-993-3475
Mailing address:
  • Phone: 240-446-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR142560
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR142560
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: