MEDICARE: STEPFANIE NICOLE PUGH NURSE PRACTITIONER

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	207Q00000X	Family Medicine Physician	R206395	MD

General Provider Information

NPI Number	:	1205600921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPFANIE NICOLE PUGH NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3215 GRANITE RD
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163-1005
Country	:	US
Telephone Number	:	443-801-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 GRANITE RD
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163-1005
Country	:	US
Telephone Number	:	443-801-0024
Fax Number	:

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

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “ STEPFANIE NICOLE PUGH NURSE PRACTITIONER” Practice Location

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