Provider Demographics
NPI:1760974844
Name:STELLWAG, LARA L (CNM)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:L
Last Name:STELLWAG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:ALMINDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:425 E 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1480
Practice Address - Country:US
Practice Address - Phone:570-387-2474
Practice Address - Fax:570-387-2397
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00065100367A00000X
NJ25ME00065101367A00000X
PAMW010665367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife