Provider Demographics
NPI:1629258439
Name:ST. VINCENT-STOLAR, SUE CAMILLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:CAMILLE
Last Name:ST. VINCENT-STOLAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 S HARGRAVE ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6169
Mailing Address - Country:US
Mailing Address - Phone:951-922-7728
Mailing Address - Fax:951-922-7730
Practice Address - Street 1:1772 GALLOWAY LN
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4516
Practice Address - Country:US
Practice Address - Phone:951-278-8183
Practice Address - Fax:951-898-2776
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282857163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health