Provider Demographics
NPI:1962150680
Name:STEWART, ANN MARIA (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 LUGINE AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4415
Mailing Address - Country:US
Mailing Address - Phone:410-900-3819
Mailing Address - Fax:
Practice Address - Street 1:1340 SMITH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3701
Practice Address - Country:US
Practice Address - Phone:410-779-1314
Practice Address - Fax:410-779-1336
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health