Provider Demographics
NPI:1720619455
Name:STADICK, EMILY G (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:G
Last Name:STADICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29995 TECHNOLOGY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2633
Mailing Address - Country:US
Mailing Address - Phone:951-461-3021
Mailing Address - Fax:951-461-8898
Practice Address - Street 1:29995 TECHNOLOGY DR STE 201
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2633
Practice Address - Country:US
Practice Address - Phone:951-461-3021
Practice Address - Fax:951-461-8898
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily