Provider Demographics
NPI:1629012786
Name:RHODES, STEPHANIE J (CNM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:RHODES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MERIDIAN BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-372-4957
Mailing Address - Fax:610-372-3735
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:MEDICAL PAVILION AT HOWARD COUNTY-SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:610-372-4957
Practice Address - Fax:610-372-3735
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR140622367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD117900400Medicaid
MD139696Medicare PIN
MDS186 / 0064OtherBLUECHOICE
165L / G893Medicare ID - Type Unspecified