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General NPI Number Information
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NPI Number | 1114754629
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Entity Type | Individual
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Provider Name | STACEY PAULE DNP, RN, PNP-AC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 112 N 82ND ST
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City | BELLEVILLE
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State | IL
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Zip | 62223-2121
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Country | US
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Telephone | 618-420-1532
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Fax |
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Provider Business Mailing Address
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Address Line | 112 N 82ND ST
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City | BELLEVILLE
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State | IL
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Zip | 62223-2121
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Country | US
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Telephone | 618-420-1532
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 2024038091
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License Number State | MO
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