Provider Demographics
NPI:1881937803
Name:STUMPEL, MARY THERESE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESE
Last Name:STUMPEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 OLDFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3128
Mailing Address - Country:US
Mailing Address - Phone:631-598-0299
Mailing Address - Fax:
Practice Address - Street 1:142 OLDFIELD AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3128
Practice Address - Country:US
Practice Address - Phone:631-598-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376948-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics