Doctor Name: | MRS. SUSAN ANNETTE STAPP |
NPI Number: | 1780924167 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 1-102990 |
Business Practice Address: | 111 Brooklyn Rd Holly Pond, AL - 350836478 |
Business Phone Number: | 2564511250 |
Business Fax Number: | |
Mailing Address: | 111 Brooklyn Rd, HOLLY POND |
State: | AL |
Postal Code: | 350836478 |
Phone Number: | 2564511250 |
Fax Number: | |
NPI Enumeration Date: | 02/22/2013 |
NPI Last Update Date: | 05/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-102990 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |