MEDICARE: MRS. STEFANIE LYNN DEFIGLIA CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN1007121	DC
2	363LF0000X	Family Nurse Practitioner	R162359	MD
3	363LF0000X	Family Nurse Practitioner	LG0000577	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24086	OTHER	DC	CHARTERED HEALTH PLAN
2	5411	OTHER	DC	HEALTH RIGHT, INC.

General Provider Information

NPI Number	:	1083779920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEFANIE LYNN DEFIGLIA CRNP

Provider Business Mailing Address
First Line	:	6095 MARSHALEE DR
Second Line	:	SUITE 100
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3532
Fax Number	:

Provider Business Practice Location Address
First Line	:	6095 MARSHALEE DR
Second Line	:	SUITE 100
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	09/06/2015

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