Provider Demographics
NPI:1386339604
Name:CHASTAIN-STULTZ, DAVID WILSON (FNP-BC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILSON
Last Name:CHASTAIN-STULTZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:WILSON
Other - Last Name:STULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:VALLEY MEDICAL GROUP, PC-NORTHAMPTON HEALTH CENTER
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1487
Mailing Address - Country:US
Mailing Address - Phone:413-586-8400
Mailing Address - Fax:866-644-0872
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:VALLEY MEDICAL GROUP, PC-NORTHAMPTON HEALTH CENTER
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1487
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:866-644-0872
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2295793163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse