Healthcare Provider Details

I. General information

NPI: 1821468836
Provider Name (Legal Business Name): STEPHANIE MARTIN EYLER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 FALLS RD #200
LUTHERVILLE MD
21093
US

IV. Provider business mailing address

10807 FALLS RD STE 200
LUTHERVILLE MD
21093-4595
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-9393
  • Fax:
Mailing address:
  • Phone: 410-321-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR195694
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: