Wall, Stacey

Wall, Stacey is an individual health care provider with primary practice located at 13123 E 16Th Ave , Aurora CO 80045-7106. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is her primary health care specialty. Wall, Stacey can be contacted via phone (720) 777-1234.

Contact Information

Primary practice address
13123 E 16Th Ave Aurora CO 80045-7106
Phone: (720) 777-1234
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 125686 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 125686 Colorado

Profile Details

NPI number 1770621930
LBN Legal business name Wall, Stacey
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2007
Last updated Jul 24th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770621930 NPPES
Colorado MEDICAID 77455274

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