Provider Demographics
NPI:1063414621
Name:STACK, BARBARA FRANCES (PCCHNP, FNP, RN)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:FRANCES
Last Name:STACK
Suffix:
Gender:F
Credentials:PCCHNP, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:BLOOMING GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:10914-0056
Mailing Address - Country:US
Mailing Address - Phone:845-496-7019
Mailing Address - Fax:845-496-7825
Practice Address - Street 1:400 OLD FORGE HILL RD
Practice Address - Street 2:VAILS GATE ELEMENTARY SCHOOL HEALTH OFFICE
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8549
Practice Address - Country:US
Practice Address - Phone:845-563-7911
Practice Address - Fax:845-563-7905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208206163W00000X
NYF320014363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health