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General NPI Number Information
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NPI Number | 1538609649
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Entity Type | Individual
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Provider Name | STACEY ISRAEL NP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 181 TAYLOR AVE
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City | COLUMBUS
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State | OH
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Zip | 43203-1779
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Country | US
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Telephone | 614-257-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 79 OAKWOOD AVE
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City | NEWARK
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State | OH
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Zip | 43055-6631
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Country | US
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Telephone | 740-755-3847
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 020060
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License Number State | OH
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