Provider Demographics
NPI:1801870746
Name:STOLLER, CARRIE A (NP-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:STOLLER
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:GASTRO-INTESTINAL ASSOCIATES, INC.
Mailing Address - Street 2:2793 SHAWNEE RD
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1444
Mailing Address - Country:US
Mailing Address - Phone:419-227-8209
Mailing Address - Fax:419-222-6007
Practice Address - Street 1:GASTRO-INTESTINAL ASSOCIATES, INC.
Practice Address - Street 2:2793 SHAWNEE RD.
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1444
Practice Address - Country:US
Practice Address - Phone:419-227-8209
Practice Address - Fax:419-222-6007
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07379363LF0000X
OHCOA.07379-NP363L00000X
OHCOA07379-NP208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415818Medicaid
OHP00864681OtherMEDICARE RR
OH2415818Medicaid
OHH038190Medicare PIN
OHSTNP13301Medicare ID - Type Unspecified