Provider Demographics
NPI:1639189426
Name:MICHEL-MOYER, EDNA ROCHELLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:ROCHELLE
Last Name:MICHEL-MOYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:EDNA
Other - Middle Name:ROCHELLE
Other - Last Name:MICHEL
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8113 VENTNOR ROAD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5728
Mailing Address - Country:US
Mailing Address - Phone:410-744-0004
Mailing Address - Fax:
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-747-2600
Practice Address - Fax:410-719-9387
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR048504363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113202400Medicaid
MD992L646EMedicare ID - Type Unspecified
MD113202400Medicaid