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General NPI Number Information
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NPI Number | 1073120960
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Entity Type | Individual
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Provider Name | STACY EDDLEMAN STUART CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 333 BUSINESS CIR
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City | PELHAM
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State | AL
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Zip | 35124-1778
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Country | US
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Telephone | 205-255-3828
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Fax | 334-625-7602
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Provider Business Mailing Address
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Address Line | 233 WINTON BLOUNT LOOP
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City | MONTGOMERY
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State | AL
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Zip | 36117-3507
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Country | US
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Telephone | 334-239-2622
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Fax | 334-625-7602
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-152622
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License Number State | AL
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