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NPI Code Detail

MEDICARE: DANICA STOUT NP

MEDICARE: DANICA STOUT NP
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
1363LF0000XFamily Nurse PractitionerAP2318AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063499234
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANICA STOUT NP
Provider Business Mailing Address
First Line : 161 WASHINGTON ST FL 14
Second Line : EIGHT TOWER BRIDGE SUITE 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428-2083
Country : US
Telephone Number : 866-825-3227
Fax Number :
Provider Business Practice Location Address
First Line : 10315 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85748-3409
Country : US
Telephone Number : 520-490-7810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 11/14/2007

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