Provider Demographics
NPI:1487209318
Name:STILL WATERS FAMILY HEALTH
Entity Type:Organization
Organization Name:STILL WATERS FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHYNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMONGELLO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:828-290-9082
Mailing Address - Street 1:53 WINDY OAKS RDG
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-7252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3101
Practice Address - Country:US
Practice Address - Phone:828-260-9082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty