Provider Demographics
NPI:1083949036
Name:RIEGERT, MONICA LYNNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LYNNE
Last Name:RIEGERT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 EASTERN AVE
Mailing Address - Street 2:A-5 EAST
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2735
Mailing Address - Country:US
Mailing Address - Phone:410-550-8124
Mailing Address - Fax:410-550-7861
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:A-5 EAST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:410-550-8124
Practice Address - Fax:410-550-7861
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036185200Medicaid
MD178656ZAEMMedicare PIN