Individual
ROSE STAHLECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0100
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18133
BLUE SHIELD
ND
01
—
18134
BLUE SHIELD
ND
01
—
19187
BLUE SHIELD
ND
01
—
19188
BLUE SHIELD
ND
01
—
25977
BLUE SHIELD
ND
01
—
28585
BLUE SHIELD
ND
01
—
28586
BLUE SHIELD
ND
01
—
970009835
TRAVELERS MEDICARE
—
Enumeration date
10/19/2005
Last updated
05/21/2008
Update your record
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