Provider Demographics
NPI:1841540218
Name:MUTH, WILLIAM HENRY HARRISON JR (MDIV, MSN, ANP, RNBC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY HARRISON
Last Name:MUTH
Suffix:JR
Gender:M
Credentials:MDIV, MSN, ANP, RNBC
Other - Prefix:
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Mailing Address - Street 1:1910 TOWNE CENTRE BLVD, UNIT 404
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-570-2515
Mailing Address - Fax:
Practice Address - Street 1:50 IRVING STREET, NWDEPT
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCRN56590363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health