Provider Demographics
NPI:1598437220
Name:STODARD, MARJORY
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:
Last Name:STODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 INVERRARY BLVD STE 309D
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4359
Mailing Address - Country:US
Mailing Address - Phone:754-367-7733
Mailing Address - Fax:954-905-7277
Practice Address - Street 1:3800 INVERRARY BLVD STE 309D
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4359
Practice Address - Country:US
Practice Address - Phone:754-367-7733
Practice Address - Fax:954-905-7277
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2933722163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty