Provider Demographics
NPI:1851173835
Name:FRU, STELLA S
Entity Type:Individual
Prefix:MS
First Name:STELLA
Middle Name:S
Last Name:FRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:S
Other - Last Name:FRU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:1203 REDCRESTED CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7081
Mailing Address - Country:US
Mailing Address - Phone:703-200-9084
Mailing Address - Fax:
Practice Address - Street 1:3611 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-909-0123
Practice Address - Fax:301-909-0050
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170770163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health