Basic Information
| Provider Information | |||||||||
| NPI: | 1619497740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOGSDILL | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | MSN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E BATTLEFIELD ST STE 124 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4179861289 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E BATTLEFIELD ST STE 124 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4179861289 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146L00000X | P16054 | MO | N | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | 163WE0003X | 2014002396 | MO | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | 2017020145 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.