Provider Demographics
NPI:1851703508
Name:METZ, MARIE CATHERINE (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CATHERINE
Last Name:METZ
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23181 VERDUGO DR STE 103A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1313
Mailing Address - Country:US
Mailing Address - Phone:949-366-1053
Mailing Address - Fax:844-734-7689
Practice Address - Street 1:4190 CITY AVE STE 528
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1635
Practice Address - Country:US
Practice Address - Phone:215-849-7700
Practice Address - Fax:844-734-7689
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029668180001Medicaid