Healthcare Provider Details

I. General information

NPI: 1114188620
Provider Name (Legal Business Name): JOANN DORACE STEVENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JOANN DORACE FIKE

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST 6A
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

10 N GREENE ST 6A
BALTIMORE MD
21201-1524
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7000
  • Fax:
Mailing address:
  • Phone: 410-605-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRO42716
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: