Provider Demographics
NPI:1487165569
Name:ANGLE, STEPHANIE CRISTAN (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CRISTAN
Last Name:ANGLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S CLINTON STREET, 5TH FLOOR
Mailing Address - Street 2:CT 05-13
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-215-1186
Mailing Address - Fax:443-753-2097
Practice Address - Street 1:1501 S CLINTON ST FL 5
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5730
Practice Address - Country:US
Practice Address - Phone:410-215-1186
Practice Address - Fax:443-753-2097
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134913171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator