Provider Demographics
NPI:1952484297
Name:SKOGLUND, MARY LOUISE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:SKOGLUND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-706-1682
Mailing Address - Fax:410-706-3243
Practice Address - Street 1:725 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1009
Practice Address - Country:US
Practice Address - Phone:410-706-1682
Practice Address - Fax:410-706-3243
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051401363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD622071100Medicaid
MD622071100Medicaid
MD142806Y2ZMedicare PIN