Healthcare Provider Details

I. General information

NPI: 1164976312
Provider Name (Legal Business Name): KATHERINE STEVENS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

1673 CAMPBELL RD
FOREST HILL MD
21050-2343
US

V. Phone/Fax

Practice location:
  • Phone: 650-360-0447
  • Fax:
Mailing address:
  • Phone: 410-838-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR164958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: