Provider Demographics
NPI:1093067753
Name:STUBBLEFIELD, SANDRA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E. BROWN STREET
Mailing Address - Street 2:
Mailing Address - City:E. STROUDBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18332
Mailing Address - Country:US
Mailing Address - Phone:570-421-3872
Mailing Address - Fax:
Practice Address - Street 1:235 E. BROWN STREET
Practice Address - Street 2:
Practice Address - City:E. STROUDBURG
Practice Address - State:PA
Practice Address - Zip Code:18332
Practice Address - Country:US
Practice Address - Phone:570-421-3872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012338363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care