Provider Demographics
NPI:1932634565
Name:STALCUP, ABAGAIL (APN)
Entity type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:
Last Name:STALCUP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5028
Mailing Address - Country:US
Mailing Address - Phone:815-634-6460
Mailing Address - Fax:
Practice Address - Street 1:32 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5028
Practice Address - Country:US
Practice Address - Phone:815-634-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015902363LF0000X
IL377001421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily