Provider Demographics
NPI:1912020074
Name:STAKEM, JOANN JOHNSON (RN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:JOHNSON
Last Name:STAKEM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7847 CREEK SHORE WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2149
Mailing Address - Country:US
Mailing Address - Phone:410-437-2276
Mailing Address - Fax:
Practice Address - Street 1:791 AQUAHART RD STE 200
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3950
Practice Address - Country:US
Practice Address - Phone:410-222-6625
Practice Address - Fax:410-222-6679
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR039432163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health