Healthcare Provider Details

I. General information

NPI: 1366577132
Provider Name (Legal Business Name): STACY A. LOURIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY LOURIE MSN,RN,APNC

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 CHRISTIANA RD.
NEW CASTLE DE
19720-0000
US

IV. Provider business mailing address

305 BEAVER CT
MULLICA HILL NJ
08062-2804
US

V. Phone/Fax

Practice location:
  • Phone: 302-322-0860
  • Fax: 302-322-4494
Mailing address:
  • Phone: 856-223-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0038026
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000500
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN08027300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: