Healthcare Provider Details

I. General information

NPI: 1518042225
Provider Name (Legal Business Name): ANN S STILWELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 SECURITY BLVD KAISER PERMANENTE PEEC DEPT
BALTIMORE MD
21244-1811
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 443-663-6406
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax: 443-663-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR107654
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR105674
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: