Provider Demographics
NPI:1437189032
Name:STAHL, MARY J (RN-NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:STAHL
Suffix:
Gender:F
Credentials:RN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SHERMAN STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1844
Mailing Address - Country:US
Mailing Address - Phone:652-225-1102
Mailing Address - Fax:
Practice Address - Street 1:360 SHERMAN STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1844
Practice Address - Country:US
Practice Address - Phone:652-225-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0270510363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S38599Medicare UPIN