Physician Compare National (NPI:1043694029)

HEALTHCARE PROVIDER: STACEY MALTMAN FNP-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1043694029
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6103128509
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151231000454
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MALTMAN
	Individual professional last name
Provider First Name	STACEY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	9051 EXECUTIVE PARK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	KNOXVILLE
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	379234626
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M