Provider Demographics
NPI:1316278203
Name:MIKELS, STACIE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:ELIZABETH
Last Name:MIKELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 KING DAVID DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22642-6327
Mailing Address - Country:US
Mailing Address - Phone:540-636-7582
Mailing Address - Fax:540-636-7582
Practice Address - Street 1:496 KING DAVID DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:VA
Practice Address - Zip Code:22642-6327
Practice Address - Country:US
Practice Address - Phone:540-636-7582
Practice Address - Fax:540-636-7582
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator