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General NPI Number Information
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NPI Number | 1598932493
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Entity Type | Individual
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Provider Name | JUDY ANN STALLCOP C.N.A
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Gender | Female
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Dates
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Enumeration Date | 05/11/2008
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Last Update Date | 05/11/2008
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Provider Practice Location Address
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Address Line | 836 W LOCUST LN
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City | NAMPA
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State | ID
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Zip | 83686-8231
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Country | US
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Telephone | 208-466-8315
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Fax | 208-468-0566
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Provider Business Mailing Address
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Address Line | 836 W LOCUST LN
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City | NAMPA
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State | ID
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Zip | 83686-8231
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Country | US
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Telephone | 208-466-8315
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Fax | 208-468-0566
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 564593
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License Number State |
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