Healthcare Provider Details

I. General information

NPI: 1437131869
Provider Name (Legal Business Name): STACEY LYNN FERREIRA C-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

22 HEWLETT RD
TOWACO NJ
07082-1308
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-6879
  • Fax:
Mailing address:
  • Phone: 845-938-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR862645
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: