Provider Demographics
NPI:1194906602
Name:DEGRANGE, MAUREEN P (CRNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:DEGRANGE
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 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 W. FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793
Practice Address - Country:US
Practice Address - Phone:301-845-6336
Practice Address - Fax:301-845-6136
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0164305-00Medicaid
MDN65553OtherCDS
MDN65553OtherCDS
MD0164305-00Medicaid
S336Medicare PIN
451LMedicare PIN