Provider Demographics
NPI:1609559038
Name:DEIGHTON, STEPHANIE GRACE (DNP, RN, ACCNS-AG)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GRACE
Last Name:DEIGHTON
Suffix:
Gender:F
Credentials:DNP, RN, ACCNS-AG
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:GRACE
Other - Last Name:OLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7705 S COVE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21219-2215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7705 S COVE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21219-2215
Practice Address - Country:US
Practice Address - Phone:443-676-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCS00200364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care