Healthcare Provider Details

I. General information

NPI: 1124638184
Provider Name (Legal Business Name): SYMONE STEPHENS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E 31ST ST # N200
BALTIMORE MD
21218-3902
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-516-3311
  • Fax: 410-516-4784
Mailing address:
  • Phone:
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAC006141
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR266153
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: