Healthcare Provider Details

I. General information

NPI: 1619768728
Provider Name (Legal Business Name): BROOKE STANLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 N EDEN ST
BALTIMORE MD
21213-2824
US

IV. Provider business mailing address

1327 N EDEN ST
BALTIMORE MD
21213-2824
US

V. Phone/Fax

Practice location:
  • Phone: 443-707-0833
  • Fax:
Mailing address:
  • Phone: 443-707-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR226302
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: