Provider Demographics
NPI:1114632346
Name:MBOUZOU, MARGUERITE (CRNP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:MBOUZOU
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 1:1589 SULPHUR SPRING RD STE 109
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:443-575-4880
Mailing Address - Fax:443-575-4891
Practice Address - Street 1:25 CROSSROADS DR STE 205
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5533
Practice Address - Country:US
Practice Address - Phone:410-602-7792
Practice Address - Fax:410-602-9889
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily