Provider Demographics
NPI:1790156891
Name:ANTORIAN CONSULTING SERVICES
Entity Type:Organization
Organization Name:ANTORIAN CONSULTING SERVICES
Other - Org Name:ANTORIAN HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AN'NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE-HEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:DRNP, FNPBC, PMHNPBC
Authorized Official - Phone:410-246-2830
Mailing Address - Street 1:3545 ELLICOTT MILLS DR PMB 204
Mailing Address - Street 2:PMB 204
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4548
Mailing Address - Country:US
Mailing Address - Phone:410-246-2830
Mailing Address - Fax:410-246-2831
Practice Address - Street 1:7004 SECURITY BLVD # 300-A27
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2557
Practice Address - Country:US
Practice Address - Phone:410-246-2830
Practice Address - Fax:410-246-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD429909400Medicaid