Basic Information
| Provider Information | |||||||||
| NPI: | 1164976312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 NORTH AVE | ||||||||
| Address2: | #101 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210142303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108386434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 NORTH AVE | ||||||||
| Address2: | #101 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210142303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108386434 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2016 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R164958 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.