Provider Demographics
NPI:1821182460
Name:STOLL, MELIA (ARNP)
Entity Type:Individual
Prefix:
First Name:MELIA
Middle Name:
Last Name:STOLL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2529
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905
Mailing Address - Country:US
Mailing Address - Phone:620-624-3811
Mailing Address - Fax:620-624-3186
Practice Address - Street 1:222 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901
Practice Address - Country:US
Practice Address - Phone:620-624-3811
Practice Address - Fax:620-624-3186
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44202207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161821OtherMEDICARE ID
KS200428500AMedicaid
KS161821OtherMEDICARE ID