Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R096361 | MD |
N | 2080P0207X | Pediatric Hematology-Oncologist | R096361 | MD |
Y | 363L00000X | Nurse Practitioner | R096361 | MD |
NPI | 1184674491 |
---|---|
Provider Name | Mrs. Stephanie M Entrup |
First Address | Baltimore, MD 21215-5216 |
Second Address | Baltimore, MD 21215-5216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 18/10/2007 |