MEDICARE: MS. STELLA LOUISE VINSON 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
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1061816	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1780832741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STELLA LOUISE VINSON NP

Provider Business Mailing Address
First Line	:	215 MEDICAL PARK DR
Second Line	:	SUITE 1
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5311
Country	:	US
Telephone Number	:	334-222-1583
Fax Number	:	334-222-1573

Provider Business Practice Location Address
First Line	:	215 MEDICAL PARK DR
Second Line	:	SUITE 1
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5311
Country	:	US
Telephone Number	:	334-222-1583
Fax Number	:	334-222-1573

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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