Provider Demographics
NPI:1952938599
Name:STOCHL, EMMAGRACE ANN (PA)
Entity Type:Individual
Prefix:
First Name:EMMAGRACE
Middle Name:ANN
Last Name:STOCHL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EMMAGRACE
Other - Middle Name:
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7170
Mailing Address - Country:US
Mailing Address - Phone:515-419-5066
Mailing Address - Fax:
Practice Address - Street 1:847 WHISPERING PINES DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-7170
Practice Address - Country:US
Practice Address - Phone:515-419-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant