Healthcare Provider Details

I. General information

NPI: 1558609701
Provider Name (Legal Business Name): STACEY MARIE MCARDLE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2105
US

IV. Provider business mailing address

92 2ND ST
HACKENSACK NJ
07601-2105
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5266
  • Fax: 551-996-0721
Mailing address:
  • Phone: 551-996-5266
  • Fax: 551-996-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00397300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: