Doctor Name: | JEFFERY D STOCKWELL |
NPI Number: | 1407957418 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | N.P. |
License Number: | R27770 |
Business Practice Address: | 202 Prospect Dr Glendive, MT - 593301943 |
Business Phone Number: | 4063453314 |
Business Fax Number: | 4063453324 |
Mailing Address: | 202 Prospect Dr, GLENDIVE |
State: | MT |
Postal Code: | 593301943 |
Phone Number: | 4063453314 |
Fax Number: | 4063453324 |
NPI Enumeration Date: | 09/25/2006 |
NPI Last Update Date: | 02/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R27770 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ND |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |