Healthcare Provider Details

I. General information

NPI: 1801870746
Provider Name (Legal Business Name): CARRIE A. STOLLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GASTRO-INTESTINAL ASSOCIATES, INC. 2793 SHAWNEE RD.
LIMA OH
45806-1444
US

IV. Provider business mailing address

GASTRO-INTESTINAL ASSOCIATES, INC. 2793 SHAWNEE RD
LIMA OH
45806-1444
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-8209
  • Fax: 419-222-6007
Mailing address:
  • Phone: 419-227-8209
  • Fax: 419-222-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number07379
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.07379-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberCOA07379-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: