Provider Demographics
NPI:1982926317
Name:RIEDT, STACY LEE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEE
Last Name:RIEDT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17112B MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2550
Mailing Address - Country:US
Mailing Address - Phone:804-883-0046
Mailing Address - Fax:804-883-0048
Practice Address - Street 1:17112B MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2550
Practice Address - Country:US
Practice Address - Phone:804-883-0046
Practice Address - Fax:804-883-0048
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily