Provider Demographics
NPI:1326335829
Name:REDDING, CAMELLE STACIAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAMELLE
Middle Name:STACIAN
Last Name:REDDING
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 1:1838 GREENE TREE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-7109
Mailing Address - Country:US
Mailing Address - Phone:410-653-0366
Mailing Address - Fax:410-601-4759
Practice Address - Street 1:1838 GREENE TREE RD STE 300
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7109
Practice Address - Country:US
Practice Address - Phone:410-653-0366
Practice Address - Fax:410-601-4759
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133694207R00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology