Individual
DR. WANIDA STOUTENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
65 BLOOMINGDALE RD, TILLSON, NY 12486-1307
(845) 658-8415
Mailing address
65 BLOOMINGDALE RD, TILLSON, NY 12486-1307
(845) 658-8415
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
N005408
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01779322
—
NY
Enumeration date
12/28/2006
Last updated
07/08/2007
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