Provider Demographics
NPI:1013912039
Name:MORETZ, GLORIA FERN (FNP CRNP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:FERN
Last Name:MORETZ
Suffix:
Gender:F
Credentials:FNP CRNP
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:FERN
Other - Last Name:GUTINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, CRNP
Mailing Address - Street 1:103 BATA BLVD
Mailing Address - Street 2:JOHN HOPKINS COMMUNITY PHYSICIANS WATERS EDGE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21017
Mailing Address - Country:US
Mailing Address - Phone:410-575-6611
Mailing Address - Fax:
Practice Address - Street 1:103 BATA BLVD
Practice Address - Street 2:JOHN HOPKINS COMMUNITY PHYSICIANS WATERS EDGE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21017
Practice Address - Country:US
Practice Address - Phone:410-575-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG24546Medicare UPIN