Provider Demographics
NPI:1063191112
Name:MOUTOUX, LUCIA M (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:M
Last Name:MOUTOUX
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 1:4913 MARINERS DR
Mailing Address - Street 2:
Mailing Address - City:SHADY SIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20764-9752
Mailing Address - Country:US
Mailing Address - Phone:443-848-8278
Mailing Address - Fax:
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-220-2333
Practice Address - Fax:301-220-2339
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily