Healthcare Provider Details

I. General information

NPI: 1699363499
Provider Name (Legal Business Name): COURTNEY SITAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 KENT TOWN MARKET
CHESTER MD
21619-2632
US

IV. Provider business mailing address

25 KENT TOWN MARKET
CHESTER MD
21619-2632
US

V. Phone/Fax

Practice location:
  • Phone: 667-343-9501
  • Fax:
Mailing address:
  • Phone: 667-343-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR212856
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberR212856
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: