Provider Demographics
NPI:1336572155
Name:MOORE-HEBRON, AN'NITA (CRNP)
Entity Type:Individual
Prefix:DR
First Name:AN'NITA
Middle Name:
Last Name:MOORE-HEBRON
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 1:3545 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
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154023363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD109658300Medicaid