Provider Demographics
NPI:1386041309
Name:STADSTAD, ANNIE P (APRN, AGAC-BC)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:P
Last Name:STADSTAD
Suffix:
Gender:F
Credentials:APRN, AGAC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 SANGER AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3379
Mailing Address - Country:US
Mailing Address - Phone:651-246-3037
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-3000
Practice Address - Fax:504-842-3989
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140093363LA2100X
FLARNP9439745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3930307-01Medicaid
LA2380184Medicaid
MS07385331Medicaid