Provider Demographics
NPI:1407802325
Name:STOCKWOOD, JANE BUTLER (MS, FNP-C, CUNP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:BUTLER
Last Name:STOCKWOOD
Suffix:
Gender:F
Credentials:MS, FNP-C, CUNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VA CTR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6719
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-621-4882
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4882
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER021829163WU0100X
MECNP81468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BENP2017Medicare ID - Type Unspecified
S90095Medicare UPIN