Provider Demographics
NPI:1538529581
Name:MCTEAGUE, CAROLINE (CRNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MCTEAGUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 FALLS RD PAVILION III
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-583-2970
Mailing Address - Fax:410-583-2980
Practice Address - Street 1:10803 FALLS ROAD PAVILION III
Practice Address - Street 2:SUITE 1500
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-583-2970
Practice Address - Fax:410-583-2980
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187520363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health