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General NPI Number Information
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NPI Number | 1114472396
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Entity Type | Individual
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Provider Name | EMILY ROSE STOUT PA
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Gender | Female
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 339 HEMINGWAY AVE
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City | EAST HAVEN
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State | CT
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Zip | 06512-5341
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Country | US
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Telephone | 203-468-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 15 SANDRA DR
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City | BRANFORD
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State | CT
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Zip | 06405-6137
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Country | US
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Telephone | 203-464-1909
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003640
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License Number State | CT
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