Provider Demographics
NPI:1609452986
Name:STETTLER, MILLICENT E (AGACNP)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:E
Last Name:STETTLER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 BUTTERCUP PL APT 303
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5631
Mailing Address - Country:US
Mailing Address - Phone:571-577-0612
Mailing Address - Fax:
Practice Address - Street 1:10850 BUTTERCUP PL APT 303
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5631
Practice Address - Country:US
Practice Address - Phone:571-577-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003667363L00000X
VA0024180423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner