Healthcare Provider Details

I. General information

NPI: 1346200557
Provider Name (Legal Business Name): NANCY S STULL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
CLARKSBURG WV
26301
US

IV. Provider business mailing address

3 TODD LN
PHILIPPI WV
26416-1245
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax: 304-626-7010
Mailing address:
  • Phone: 304-457-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number340
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: