Provider Demographics
NPI:1336551605
Name:ZICKL, STACY E (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:E
Last Name:ZICKL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:590 COURT ST
Mailing Address - Street 2:DHC - ORTHOPAEDICS
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1719
Mailing Address - Country:US
Mailing Address - Phone:603-354-5482
Mailing Address - Fax:603-354-5483
Practice Address - Street 1:590 COURT ST
Practice Address - Street 2:DHC - ORTHOPAEDICS
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1719
Practice Address - Country:US
Practice Address - Phone:603-354-5482
Practice Address - Fax:603-354-5483
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2021-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH1025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant