Provider Demographics
NPI:1346589553
Name:FELLOWS, STACI R (MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:R
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64342 ENDLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-7509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:119 W MAIN ST
Practice Address - Street 2:
Practice Address - City:QUAKER CITY
Practice Address - State:OH
Practice Address - Zip Code:43773-9422
Practice Address - Country:US
Practice Address - Phone:740-239-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16293363LF0000X
MSR871067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily