Provider Demographics
NPI:1205600921
Name:PUGH, STEPFANIE NICOLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:STEPFANIE
Middle Name:NICOLE
Last Name:PUGH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 GRANITE RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1005
Mailing Address - Country:US
Mailing Address - Phone:443-801-0024
Mailing Address - Fax:
Practice Address - Street 1:3215 GRANITE RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1005
Practice Address - Country:US
Practice Address - Phone:443-801-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine