Provider Demographics
NPI:1366577132
Name:LOURIE, STACY A (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:LOURIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:LOURIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,RN,APNC
Mailing Address - Street 1:305 BEAVER CT
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2804
Mailing Address - Country:US
Mailing Address - Phone:856-223-8872
Mailing Address - Fax:
Practice Address - Street 1:239 CHRISTIANA RD.
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-0000
Practice Address - Country:US
Practice Address - Phone:302-322-0860
Practice Address - Fax:302-322-4494
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0038026163W00000X
DELG-0000500363LF0000X
NJ26NN08027300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS43942Medicare UPIN
NJL01277Medicare ID - Type Unspecified
DE159162YZHMedicare PIN