Provider Demographics
NPI:1982424131
Name:EDWARDS, STACY LEE (CRNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2941
Mailing Address - Country:US
Mailing Address - Phone:443-465-6941
Mailing Address - Fax:
Practice Address - Street 1:227 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:MD
Practice Address - Zip Code:21227-2941
Practice Address - Country:US
Practice Address - Phone:443-465-6941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151855363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health