Basic Information
| Provider Information | |||||||||
| NPI: | 1649636101 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLDINSKY | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RILEY | ||||||||
| OtherFirstName: | STACIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR | ||||||||
| Address2: | SUITE 2300 - PHYSICIAN CONTRACTING | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4735 OGLETOWN STANTON RD | ||||||||
| Address2: | HEALTHCARE CENTER AT MAP 2, SUITE 1250 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026230200 | ||||||||
| FaxNumber: | 3026230217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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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 | 163W00000X | L1-0036765 | DE | N | Nursing Service Providers | Registered Nurse | 363LF0000X | LG-0000905 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.