Basic Information
| Provider Information | |||||||||
| NPI: | 1144312018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STELZNER | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 MARY ST | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649664 | ||||||||
| FaxNumber: | 8282648144 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 MARY ST | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649664 | ||||||||
| FaxNumber: | 8282648144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP2743712 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 235865 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | NC5008A746 | 01 | NC | MEDICARE PTAN | OTHER | 1144312018 | 05 | NC | MEDICAID | 306603700 | 05 | FL | MEDICAID |