MEDICARE: DAVID STABLER APRN-PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0030798	OH

General Provider Information

NPI Number	:	1003562604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID STABLER APRN-PMHNP

Provider Business Mailing Address
First Line	:	14805 DETROIT AVE STE 250
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3924
Country	:	US
Telephone Number	:	216-250-4937
Fax Number	:	216-516-0471

Provider Business Practice Location Address
First Line	:	14805 DETROIT AVE STE 250
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3924
Country	:	US
Telephone Number	:	216-250-4937
Fax Number	:	216-516-0471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	01/27/2026

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