Doctor Name: | STACY LEIGH SEDERWALL |
NPI Number: | 1255720876 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2015001255 |
Business Practice Address: | 1057 Medical Park Dr Ste A Osage Beach, MO - 650653000 |
Business Phone Number: | 5733023200 |
Business Fax Number: | 5733023210 |
Mailing Address: | Po Box 1500, OSAGE BEACH |
State: | MO |
Postal Code: | 650651500 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/20/2015 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2015001255 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |