Basic Information
| Provider Information | |||||||||
| NPI: | 1538767959 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCVICKER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 CHARLES ST | ||||||||
| Address2: | |||||||||
| City: | SCHELLSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155598310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144941905 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12500 WILLOWBROOK RD | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215026393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2409641200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2020 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R209075 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.