Provider Demographics
NPI:1457321564
Name:ZIBEL, STACIE (APRN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:ZIBEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 WILLARD AVE
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2373
Mailing Address - Country:US
Mailing Address - Phone:860-665-1571
Mailing Address - Fax:860-667-3668
Practice Address - Street 1:365 WILLARD AVE
Practice Address - Street 2:SUITE 2-D
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2373
Practice Address - Country:US
Practice Address - Phone:860-665-1571
Practice Address - Fax:860-667-3668
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS45806Medicare UPIN