Provider Demographics
NPI:1558728071
Name:CHUBB, STACY L (CRNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:CHUBB
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1 DOCK HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-8910
Practice Address - Country:US
Practice Address - Phone:570-837-5889
Practice Address - Fax:570-837-6600
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015833363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner