Healthcare Provider Details

I. General information

NPI: 1386697282
Provider Name (Legal Business Name): STACY LYNN FILION PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY LYNN FUDALA PA-C

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W HOLLIS ST SUITE 111
NASHUA NH
03062-1358
US

IV. Provider business mailing address

505 W HOLLIS ST SUITE 111
NASHUA NH
03062-1358
US

V. Phone/Fax

Practice location:
  • Phone: 603-579-9648
  • Fax: 603-579-9647
Mailing address:
  • Phone: 603-579-9648
  • Fax: 603-579-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: