Provider Demographics
NPI:1235779943
Name:OBERHAUSER, STACEY (CRNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:OBERHAUSER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:KUNKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7690 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1945
Mailing Address - Country:US
Mailing Address - Phone:610-301-9558
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR UROLOGIC CARE OF BERKS COUNTY
Practice Address - Street 2:1320 BROADCASTING ROAD, SUITE 200
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-372-8995
Practice Address - Fax:610-372-7922
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology