Healthcare Provider Details

I. General information

NPI: 1215177159
Provider Name (Legal Business Name): NANCY ANN STALLARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NANCY ANN AMATO

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE CDCR
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

2401 W BELVEDERE AVE CDCR
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8450
  • Fax: 410-601-1470
Mailing address:
  • Phone: 410-601-8450
  • Fax: 410-601-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRO84934
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: