Individual
MS. KELLEY J. STEFANCIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
255 HOSPITAL DR STE 208, GLEN BURNIE, MD 21061-5801
(410) 553-8160
(410) 553-8159
Mailing address
301 HOSPITAL DR, STE 803, GLEN BURNIE, MD 21061-5803
(410) 553-8160
(410) 553-8159
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
R120913
MD
207X00000X
Orthopaedic Surgery Physician
R120913
MD
208600000X
Surgery Physician
Primary
R120913
MD
363LF0000X
Family Nurse Practitioner
R120913
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11583185
CAQH
—
01
—
216966
BRAVO HEALTH
—
01
—
3405544
CIGNA
—
01
—
546903-14 8756-0002
CAREFIRST BLUE CROSS BLUE SHIELD
—
05
—
680010600
—
MD
Enumeration date
08/17/2005
Last updated
01/23/2024
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