Provider Demographics
NPI:1023206976
Name:STAPE, JILL MARIE I
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:STAPE
Suffix:I
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:STAPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:9809 CANDELARIA RD NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1458
Mailing Address - Country:US
Mailing Address - Phone:505-298-4325
Mailing Address - Fax:
Practice Address - Street 1:9809 CANDELARIA RD NE
Practice Address - Street 2:SUITE 3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1458
Practice Address - Country:US
Practice Address - Phone:505-298-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist