Provider Demographics
NPI:1558671487
Name:STALKER, DOUGLAS JAMES (RN)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:STALKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:DOUGLAS
Other - Middle Name:JAMES
Other - Last Name:STALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:15 JOYS LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3705
Mailing Address - Country:US
Mailing Address - Phone:845-331-5064
Mailing Address - Fax:
Practice Address - Street 1:15 JOYS LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3705
Practice Address - Country:US
Practice Address - Phone:845-331-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353104-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult