Provider Demographics
NPI:1932453115
Name:CROSS, STACY M (CRNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:CROSS
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:2301 DORSEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3299
Mailing Address - Country:US
Mailing Address - Phone:443-576-0909
Mailing Address - Fax:410-265-5294
Practice Address - Street 1:1506 WOODLAWN DR
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4035
Practice Address - Country:US
Practice Address - Phone:443-576-0909
Practice Address - Fax:410-265-5294
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2017-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR166058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS582Medicare PIN