Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 11040 | TN |
NPI | 1093068140 |
---|---|
Provider Name | Mrs. Roxanne Rie Stahl |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2012 |
Last Update Date | 30/10/2020 |