Provider Demographics
NPI:1467693796
Name:MOORE- DUGGAN MS, CRNP, TONI JEANNE (MS, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:JEANNE
Last Name:MOORE- DUGGAN MS, CRNP
Suffix:
Gender:F
Credentials:MS, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 HARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3914
Mailing Address - Country:US
Mailing Address - Phone:410-532-8477
Mailing Address - Fax:
Practice Address - Street 1:523 HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3914
Practice Address - Country:US
Practice Address - Phone:410-532-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR053926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD865200700Medicaid
MD865200700Medicaid