Healthcare Provider Details

I. General information

NPI: 1619405289
Provider Name (Legal Business Name): STEPHANIE WALLBILLICH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 RIDGEBROOK RD STE 300
SPARKS MD
21152-9477
US

IV. Provider business mailing address

3910 ADLER PL
BETHLEHEM PA
18017-9299
US

V. Phone/Fax

Practice location:
  • Phone: 484-619-0900
  • Fax:
Mailing address:
  • Phone: 610-297-3100
  • Fax: 610-273-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP017627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: