Basic Information
| Provider Information | |||||||||
| NPI: | 1982255774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAHL | ||||||||
| FirstName: | JUSTINE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CNRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4643 JACKSON RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080947642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567614947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1505 W SHERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083607059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566418000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2019 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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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 | 367500000X | 26NJ00969800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.