=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013174820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACEY DUNKELBERGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2250 HICKORY RD
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-834-1122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9145 ROUTE 35
-----------------------------------------------------
City | MOUNT PLEASANT MILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17853-8495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 9979688
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------