Healthcare Provider Details

I. General information

NPI: 1053785477
Provider Name (Legal Business Name): LOUISE STEVENS CRNP, FNP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SULPHUR SPRING RD
BALTIMORE MD
21227-2701
US

IV. Provider business mailing address

3 MILLPAINT LANE APT 3A
OWINGS MILLS MD
21117
US

V. Phone/Fax

Practice location:
  • Phone: 410-737-9221
  • Fax:
Mailing address:
  • Phone: 412-425-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR180395
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR180395
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: