1639189426 NPI number — MRS. EDNA ROCHELLE MICHEL-MOYER C.R.N.P.

Table of content: MRS. EDNA ROCHELLE MICHEL-MOYER C.R.N.P. (NPI 1639189426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639189426 NPI number — MRS. EDNA ROCHELLE MICHEL-MOYER C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHEL-MOYER
Provider First Name:
EDNA
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICHEL
Provider Other First Name:
EDNA
Provider Other Middle Name:
ROCHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639189426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8113 VENTNOR ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-5728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-744-0004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 FREDERICK RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-747-2600
Provider Business Practice Location Address Fax Number:
410-719-9387
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R048504 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113202400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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