Provider Demographics
NPI:1902211063
Name:LOBELLO, STACY L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:LOBELLO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 DELMAR BLVD STE B560
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3084
Mailing Address - Country:US
Mailing Address - Phone:314-833-4030
Mailing Address - Fax:314-833-4031
Practice Address - Street 1:5000 CEDAR PLAZA PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3854
Practice Address - Country:US
Practice Address - Phone:314-849-7669
Practice Address - Fax:314-849-7670
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014014282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily