Provider Demographics
NPI:1447746144
Name:WETTENGEL, CAROLINE MOUGHON (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MOUGHON
Last Name:WETTENGEL
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 1:101 CARRAWAY LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3757
Mailing Address - Country:US
Mailing Address - Phone:571-277-5489
Mailing Address - Fax:
Practice Address - Street 1:9891 BROKEN LAND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1156
Practice Address - Country:US
Practice Address - Phone:571-277-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily