Healthcare Provider Details

I. General information

NPI: 1467376632
Provider Name (Legal Business Name): WILLS STADIN PIERRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 THOMAS JOHNSON DR STE 9
FREDERICK MD
21702-4443
US

IV. Provider business mailing address

198 THOMAS JOHNSON DR STE 9
FREDERICK MD
21702-4443
US

V. Phone/Fax

Practice location:
  • Phone: 240-779-1498
  • Fax:
Mailing address:
  • Phone: 240-226-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR246345
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: