Provider Demographics
NPI:1154889558
Name:STECK, CORRINA (CRNP)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:
Last Name:STECK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 NOTCHCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9447
Mailing Address - Country:US
Mailing Address - Phone:410-227-7588
Mailing Address - Fax:
Practice Address - Street 1:24 SCHILLING RD STE 1
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1105
Practice Address - Country:US
Practice Address - Phone:410-771-7609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine