Healthcare Provider Details

I. General information

NPI: 1457081838
Provider Name (Legal Business Name): STEPHENIE ANN GUTRIDGE-SNODE MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 09/04/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41680 MISS BESSIE DR STE 301
LEONARDTOWN MD
20650-2965
US

IV. Provider business mailing address

41680 MISS BESSIE DR STE 301
LEONARDTOWN MD
20650-2965
US

V. Phone/Fax

Practice location:
  • Phone: 240-526-7076
  • Fax:
Mailing address:
  • Phone: 240-526-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR216242
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR216242
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: