Provider Demographics
NPI:1881155901
Name:STEPHENSON, PRINCESS (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PRINCESS
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:P. MARIE
Other - Middle Name:
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:23202 BREWERS TAVERN WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4391
Mailing Address - Country:US
Mailing Address - Phone:301-298-9919
Mailing Address - Fax:301-298-9917
Practice Address - Street 1:23202 BREWERS TAVERN WAY
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4391
Practice Address - Country:US
Practice Address - Phone:301-298-9919
Practice Address - Fax:301-298-9917
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily