Provider Demographics
NPI:1689980641
Name:PANCHELLA, STACY LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:PANCHELLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1832
Mailing Address - Country:US
Mailing Address - Phone:215-752-2424
Mailing Address - Fax:215-750-1927
Practice Address - Street 1:240 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1832
Practice Address - Country:US
Practice Address - Phone:215-752-2424
Practice Address - Fax:215-750-1927
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010946363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
196896DZTMedicare PIN