Provider Demographics
NPI:1215787106
Name:BARTHOLOMEW, STACIE (RN BSN CWON)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:RN BSN CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5917
Mailing Address - Country:US
Mailing Address - Phone:484-619-5563
Mailing Address - Fax:
Practice Address - Street 1:1333 BLAIR ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5917
Practice Address - Country:US
Practice Address - Phone:484-619-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2005458166163WE0900X
WI20054566898163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy