Provider Demographics
NPI:1760627525
Name:STEFFY, CAROL JEAN
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:STEFFY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-832-2729
Mailing Address - Fax:410-832-5783
Practice Address - Street 1:901 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 129
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2600
Practice Address - Country:US
Practice Address - Phone:410-832-2729
Practice Address - Fax:410-832-5783
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR034733364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist