Provider Demographics
NPI:1467487942
Name:STEMMER, MARYELLEN (DO)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:STEMMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3719
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-3719
Mailing Address - Country:US
Mailing Address - Phone:530-751-3880
Mailing Address - Fax:530-751-5046
Practice Address - Street 1:483 GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-9389
Practice Address - Country:US
Practice Address - Phone:530-751-3880
Practice Address - Fax:530-751-5046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC29995Medicare UPIN