Healthcare Provider Details

I. General information

NPI: 1952764854
Provider Name (Legal Business Name): STACY GWATURA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WEST BELVEDERE AVENUE SINAI HOSPITAL
BALTIMORE MD
21215
US

IV. Provider business mailing address

2401 WEST BELVEDERE AVENUE SINAI HOSPITAL
BALTIMORE MD
21215
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9000
  • Fax:
Mailing address:
  • Phone: 410-601-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR203908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: