Healthcare Provider Details

I. General information

NPI: 1477569713
Provider Name (Legal Business Name): BARBARA ROSE STAHL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DURHAM RD A2
GUILFORD CT
06437-2076
US

IV. Provider business mailing address

5 DURHAM ROAD, A2
GULIFORD CT
06437
US

V. Phone/Fax

Practice location:
  • Phone: 203-458-4440
  • Fax: 203-458-4443
Mailing address:
  • Phone: 203-458-4440
  • Fax: 203-458-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002110
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR21207
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: