Provider Demographics
NPI:1316697873
Name:KNAPP, STACIE NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:NICOLE
Last Name:KNAPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 JENKINS LN
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9730
Mailing Address - Country:US
Mailing Address - Phone:443-844-7367
Mailing Address - Fax:
Practice Address - Street 1:9 SCHILLING RD STE 102
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-8611
Practice Address - Country:US
Practice Address - Phone:410-771-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily