Individual
CARA STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-6230
Mailing address
1376 ANCHOR ST, PHILADELPHIA, PA 19124-1204
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN546762
PA
363LA2100X
Acute Care Nurse Practitioner
Primary
SP013491
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103186947
—
PA
Enumeration date
09/03/2009
Last updated
11/09/2016
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