Provider Demographics
NPI:1962860601
Name:MACPAINTSIL-OSTROM, STACEY A (MSN, APN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:MACPAINTSIL-OSTROM
Suffix:
Gender:F
Credentials:MSN, APN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:856-348-1137
Mailing Address - Fax:856-524-7365
Practice Address - Street 1:1000 WHITE HORSE RD
Practice Address - Street 2:SUITE 803
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4406
Practice Address - Country:US
Practice Address - Phone:856-278-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00610700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health