Healthcare Provider Details

I. General information

NPI: 1619958683
Provider Name (Legal Business Name): STACEY T HERSH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE STE 202
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

3213 JOHN MARSHALL DR
ARLINGTON VA
22207-1370
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-9101
  • Fax: 301-681-3525
Mailing address:
  • Phone: 703-534-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAC000776
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAC000776
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: