Provider Demographics
NPI:1437230414
Name:MERROW, STACY (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MERROW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:GERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6560
Mailing Address - Fax:814-372-2848
Practice Address - Street 1:120 RADNOR RD
Practice Address - Street 2:STE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7970
Practice Address - Country:US
Practice Address - Phone:814-231-7868
Practice Address - Fax:814-238-4169
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAMA003108L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant