Healthcare Provider Details

I. General information

NPI: 1346434206
Provider Name (Legal Business Name): KAREN AILEEN STADD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N WOLFE ST
BALTIMORE MD
21287-0004
US

IV. Provider business mailing address

601 N WOLFE ST
BALTIMORE MD
21287-3200
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5255
  • Fax: 410-614-8834
Mailing address:
  • Phone: 410-955-5255
  • Fax: 410-614-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR115148
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: