Stacy T Sullenberger
Nurse Practitioner - Pediatrics
662 N Main St
Springboro
, Ohio 45066-9553
Stacy T Sullenberger
Nurse Practitioner - Pediatrics
662 N Main St
Springboro
, Ohio 45066-9553
(937) 641-3555
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About
Features
Specialties
- Nurse Practitioner - Pediatrics
Languages spoken
- English
Location
First Address
- Stacy T Sullenberger
- 1 Childrens Plz
- Dayton, OH
- Zip : 45404-1815
- Phone : (937) 641-3555
Second Address
- Stacy T Sullenberger
- 662 N Main St
- Springboro, OH
- Zip : 45066-9553
- Fax : (937) 550-9797
- Phone : (937) 641-5066
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN.CNP.14148 | OH |
National Provider Identifier
| NPI | 1023355484 |
|---|---|
| Provider Name | Stacy T Sullenberger |
| First Address | Dayton, OH 45404-1815 |
| Second Address | Springboro, OH 45066-9553 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/01/2013 |
| Last Update Date | 03/02/2022 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0330291 | (05) | OH |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.