Provider Demographics
NPI:1144646076
Name:DUGAN, NICOLE MARIE (CPNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:DUGAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 LASALLE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2008
Mailing Address - Country:US
Mailing Address - Phone:410-823-5232
Mailing Address - Fax:
Practice Address - Street 1:8600 LASALLE RD
Practice Address - Street 2:STE 105
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2008
Practice Address - Country:US
Practice Address - Phone:410-823-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177574363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics