Provider Demographics
NPI:1962860601
Name:MACPAINTSIL-OSTROM, STACEY A (MSN, APN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:MACPAINTSIL-OSTROM
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Gender:
Credentials:MSN, APN, PMHNP-BC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1474 TANYARD RD STE C100
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4222
Mailing Address - Country:US
Mailing Address - Phone:855-566-6406
Mailing Address - Fax:856-566-6320
Practice Address - Street 1:1474 TANYARD RD STE C100
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4222
Practice Address - Country:US
Practice Address - Phone:855-932-7476
Practice Address - Fax:856-566-6320
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2025-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00610700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health