Healthcare Provider Details

I. General information

NPI: 1386504777
Provider Name (Legal Business Name): NADINE ILANA SIMPSON CRNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 ELM AVE
BALTIMORE MD
21211-2401
US

IV. Provider business mailing address

3642 ELM AVE
BALTIMORE MD
21211-2401
US

V. Phone/Fax

Practice location:
  • Phone: 201-220-5521
  • Fax:
Mailing address:
  • Phone: 201-220-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR202348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: