Provider Demographics
NPI:1477569713
Name:STAHL, BARBARA ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ROSE
Last Name:STAHL
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 1:5 DURHAM ROAD, A2
Mailing Address - Street 2:
Mailing Address - City:GULIFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437
Mailing Address - Country:US
Mailing Address - Phone:203-458-4440
Mailing Address - Fax:203-458-4443
Practice Address - Street 1:5 DURHAM RD
Practice Address - Street 2:A2
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-458-4440
Practice Address - Fax:203-458-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR21207163W00000X
CT002110363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002110OtherAPRN LISENSE
CTR20107OtherREGISTERED NURSE LICENSE