Provider Demographics
NPI:1134183346
Name:STOOPS, GWENDOLYN LORRAINE (LVN)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:LORRAINE
Last Name:STOOPS
Suffix:
Gender:F
Credentials:LVN
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 63009
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063
Mailing Address - Country:US
Mailing Address - Phone:830-510-6466
Mailing Address - Fax:830-537-4082
Practice Address - Street 1:13 NOTTINGHAM LN
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-537-4078
Practice Address - Fax:830-537-4082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111987164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse