Healthcare Provider Details

I. General information

NPI: 1467916148
Provider Name (Legal Business Name): STACY REEVES HOENES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY MARIE REEVES

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 PARK HEIGHTS AVE
BALTIMORE MD
21215-6725
US

IV. Provider business mailing address

13835 KENNARD DR
GLENELG MD
21737-9751
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-8130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR201835
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR201835
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: