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NPI Code Detail

MEDICARE: MAKENZIE STOTLER

MEDICARE: MAKENZIE STOTLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1992461362
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENZIE STOTLER
Provider Business Mailing Address
First Line : 200 ASSOCIATION DR STE 130
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1277
Country : US
Telephone Number : 304-988-4200
Fax Number :
Provider Business Practice Location Address
First Line : 5310 SPECTRUM DR
Second Line :
City : FREDERICK
State : MD
Zip : 21703-7362
Country : US
Telephone Number : 301-337-8833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2021
Last Update Date : 03/07/2023

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Directions to “ MAKENZIE STOTLER ” Practice Location

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