Healthcare Provider Details

I. General information

NPI: 1124240841
Provider Name (Legal Business Name): MARY A STAVROPOULOS APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 POPLAR AVE
GERMANTOWN TN
38138-3904
US

IV. Provider business mailing address

7179 N GERMANWOOD CT
MEMPHIS TN
38125-2008
US

V. Phone/Fax

Practice location:
  • Phone: 901-229-6665
  • Fax:
Mailing address:
  • Phone: 901-755-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000012558
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: