Healthcare Provider Details

I. General information

NPI: 1548975253
Provider Name (Legal Business Name): STEPHEN NICEWARNER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9093 RIDGEFIELD DR STE 104
FREDERICK MD
21701-6711
US

IV. Provider business mailing address

9093 RIDGEFIELD DR STE 104
FREDERICK MD
21701-6711
US

V. Phone/Fax

Practice location:
  • Phone: 240-956-5475
  • Fax: 240-891-2600
Mailing address:
  • Phone: 240-956-5475
  • Fax: 240-891-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR228108
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: