Healthcare Provider Details

I. General information

NPI: 1225284383
Provider Name (Legal Business Name): KATARINA STEACY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W BALTIMORE ST
BALTIMORE MD
21201-1110
US

IV. Provider business mailing address

6324 WIND RIDER WAY
COLUMBIA MD
21045-7414
US

V. Phone/Fax

Practice location:
  • Phone: 410-369-5200
  • Fax:
Mailing address:
  • Phone: 240-426-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR167398
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1014507
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: