Provider Demographics
NPI:1407153976
Name:MALTESE, STACY BRYNN (RN, BSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:BRYNN
Last Name:MALTESE
Suffix:
Gender:F
Credentials:RN, BSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STADIUM DRIVE
Mailing Address - Street 2:WVU HOSPITAL, PRE-ADMISSION TESTING
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2817
Mailing Address - Country:US
Mailing Address - Phone:304-598-6338
Mailing Address - Fax:
Practice Address - Street 1:1 STADIUM DR
Practice Address - Street 2:PRE-ADMISSION TESTING, POC
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-7900
Practice Address - Country:US
Practice Address - Phone:304-598-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV70762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily