Provider Demographics
NPI:1538442694
Name:STAPLETON, MACY LERIN (BC-PNP)
Entity type:Individual
Prefix:MRS
First Name:MACY
Middle Name:LERIN
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:BC-PNP
Other - Prefix:MS
Other - First Name:MACY
Other - Middle Name:LERIN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-PNP
Mailing Address - Street 1:2101 EXECUTIVE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3089
Mailing Address - Country:US
Mailing Address - Phone:757-838-8166
Mailing Address - Fax:757-838-8233
Practice Address - Street 1:2101 EXECUTIVE DR STE 160
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3089
Practice Address - Country:US
Practice Address - Phone:757-838-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171695363LP0200X
TX828164363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics