Provider Demographics
NPI:1144530056
Name:KLUGMAN, MINDY I (CRNP-ACP)
Entity type:Individual
Prefix:MS
First Name:MINDY
Middle Name:I
Last Name:KLUGMAN
Suffix:
Gender:F
Credentials:CRNP-ACP
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Mailing Address - Street 1:1708 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4596
Mailing Address - Country:US
Mailing Address - Phone:410-578-8600
Mailing Address - Fax:410-367-4196
Practice Address - Street 1:1708 W ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4596
Practice Address - Country:US
Practice Address - Phone:410-578-8600
Practice Address - Fax:410-367-4196
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR098385363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics