Provider Demographics
NPI:1740622240
Name:BERLEKAMP SPATAR, STACY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:BERLEKAMP SPATAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 KIETZKE LN STE 104
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2043
Mailing Address - Country:US
Mailing Address - Phone:775-348-8800
Mailing Address - Fax:775-348-8818
Practice Address - Street 1:9990 DOUBLE R BLVD STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4833
Practice Address - Country:US
Practice Address - Phone:775-348-8800
Practice Address - Fax:775-348-8818
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV829333363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250008105Medicaid
OH0089251Medicaid