Individual
STACIA LARK MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1501 DIVISION ST, BALTIMORE, MD 21217-3121
(410) 383-8300
Mailing address
7789 ARUNDEL MILLS BLVD APT 311, HANOVER, MD 21076-2020
(443) 600-4886
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R225927
MD
Other
Enumeration date
02/02/2023
Last updated
03/08/2023
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