Provider Demographics
NPI:1962822320
Name:FUGAR, STELLA (RN)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:FUGAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 199TH ST
Mailing Address - Street 2:APT# 55
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2911
Mailing Address - Country:US
Mailing Address - Phone:646-384-0489
Mailing Address - Fax:
Practice Address - Street 1:400 E 199TH ST
Practice Address - Street 2:APT# 55
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2911
Practice Address - Country:US
Practice Address - Phone:646-384-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682845-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse