Provider Demographics
NPI:1164468641
Name:PRN MEDICAL RESOURCE, PLLC
Entity Type:Organization
Organization Name:PRN MEDICAL RESOURCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:STIERWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:828-693-8900
Mailing Address - Street 1:828 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3540
Mailing Address - Country:US
Mailing Address - Phone:828-693-8900
Mailing Address - Fax:828-693-8880
Practice Address - Street 1:828 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3540
Practice Address - Country:US
Practice Address - Phone:828-693-8900
Practice Address - Fax:828-693-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC561817172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0245KOtherBCBS PROVIDER NUMBER
NC720245KMedicaid