Provider Demographics
NPI:1073925848
Name:UMPEROVITCH, STACIE LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LYNNE
Last Name:UMPEROVITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:L
Other - Last Name:FOOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14 ARMORY RD
Mailing Address - Street 2:DARTMOUTH HITCHCOCK - FAMILY MEDICINE
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3405
Mailing Address - Country:US
Mailing Address - Phone:603-673-2515
Mailing Address - Fax:
Practice Address - Street 1:14 ARMORY RD
Practice Address - Street 2:DARTMOUTH HITCHCOCK - FAMILY MEDICINE
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3405
Practice Address - Country:US
Practice Address - Phone:603-673-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1117037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical