Provider Demographics
NPI:1306268768
Name:STAHL, ANGELA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11490 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033-8732
Mailing Address - Country:US
Mailing Address - Phone:315-753-0063
Mailing Address - Fax:315-753-0063
Practice Address - Street 1:11490 WHITE RD
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033-8732
Practice Address - Country:US
Practice Address - Phone:315-753-0063
Practice Address - Fax:315-753-0063
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-19
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230759-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse