Provider Demographics
NPI:1336397942
Name:MOTOVIDLAK, APRIL LYN (CRNP)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:LYN
Last Name:MOTOVIDLAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:
Practice Address - Street 1:2977 FOUR H PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2237
Practice Address - Country:US
Practice Address - Phone:410-758-4030
Practice Address - Fax:410-758-4733
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144963364SA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGMedicaid
PENDINGMedicare PIN