Healthcare Provider Details

I. General information

NPI: 1336541978
Provider Name (Legal Business Name): ELLA MARIA STALLINGS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE
FORT MEADE MD
20755
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT MEADE MD
20755
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8800
  • Fax:
Mailing address:
  • Phone: 301-677-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC002124
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number177844
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: