Provider Demographics
NPI:1114754629
Name:PAULE, STACEY (DNP, RN, PNP-AC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:PAULE
Suffix:
Gender:F
Credentials:DNP, RN, PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 82ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2121
Mailing Address - Country:US
Mailing Address - Phone:618-420-1532
Mailing Address - Fax:
Practice Address - Street 1:112 N 82ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2121
Practice Address - Country:US
Practice Address - Phone:618-420-1532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024038091363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care