Healthcare Provider Details

I. General information

NPI: 1750889614
Provider Name (Legal Business Name): STACY LYNN MIHLEK DNP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MAIN ST
GREAT BARRINGTON MA
01230-1822
US

IV. Provider business mailing address

44 FULLER ST
LEE MA
01238-1302
US

V. Phone/Fax

Practice location:
  • Phone: 413-644-6499
  • Fax:
Mailing address:
  • Phone: 413-822-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number278060
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: