Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 2020-03271 | NC |
N | 2080P0210X | Pediatric Nephrologist | MD.MD.60730325 | WA |
NPI | 1336464759 |
---|---|
Provider Name | Jessica Lauren Stahl |
First Address | Morrisville, NC 27560-8442 |
Second Address | Sanford, NC 27330-4159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 10/08/2021 |