Provider Demographics
NPI:1558541110
Name:KATHERINE A. NUGENT, P. A., INC.
Entity Type:Organization
Organization Name:KATHERINE A. NUGENT, P. A., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:410-967-7950
Mailing Address - Street 1:205 E JOPPA RD APT 1209
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3281
Mailing Address - Country:US
Mailing Address - Phone:410-967-7950
Mailing Address - Fax:
Practice Address - Street 1:100 WEST RD STE 229
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2331
Practice Address - Country:US
Practice Address - Phone:410-825-3131
Practice Address - Fax:410-825-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-11
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069863367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD553121703Medicaid