Provider Demographics
NPI:1215177159
Name:STALLARD, NANCY ANN (CRNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:STALLARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:AMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:CDCR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-8450
Mailing Address - Fax:410-601-1470
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:CDCR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-8450
Practice Address - Fax:410-601-1470
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO84934363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS589Medicare PIN
MDS574Medicare PIN
MD182705YSHMedicare PIN
MD182705Y8SMedicare PIN