Provider Demographics
NPI:1316154586
Name:STEVENSON, TERRY LYNN (MS CRNP)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LYNN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MS CRNP
Other - Prefix:
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Mailing Address - Street 1:8831 SATYR HILL ROAD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-4230
Mailing Address - Country:US
Mailing Address - Phone:410-668-4300
Mailing Address - Fax:410-668-3744
Practice Address - Street 1:8831 SATYR HILL ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4230
Practice Address - Country:US
Practice Address - Phone:410-668-4300
Practice Address - Fax:410-668-3744
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD605MMedicare PIN