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NPI Code Detail

MEDICARE: JEAN STAPLES CRNP

MEDICARE: JEAN STAPLES 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
1363LX0001XObstetrics & Gynecology Nurse PractitionerR039586MD

General Provider Information

NPI Number : 1518057371
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN STAPLES CRNP
Provider Business Mailing Address
First Line : 97 WINCHESTER CT
Second Line :
City : PORT DEPOSIT
State : MD
Zip : 21904-1558
Country : US
Telephone Number : 410-378-4306
Fax Number :
Provider Business Practice Location Address
First Line : 119 S HAYS ST
Second Line :
City : BEL AIR
State : MD
Zip : 21014-3644
Country : US
Telephone Number : 410-638-8484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 07/08/2007

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