Healthcare Provider Details

I. General information

NPI: 1962860601
Provider Name (Legal Business Name): STACEY A. MACPAINTSIL-OSTROM MSN, APN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 TANYARD RD STE C100
SEWELL NJ
08080-4222
US

IV. Provider business mailing address

1474 TANYARD RD STE C100
SEWELL NJ
08080-4222
US

V. Phone/Fax

Practice location:
  • Phone: 855-932-7476
  • Fax: 856-566-6320
Mailing address:
  • Phone: 855-566-6406
  • Fax: 856-566-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00610700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: