Provider Demographics
NPI:1447785654
Name:STAVLUND, STACY (CNM)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:STAVLUND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 WILLOW OAKS CORPORATE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4527
Mailing Address - Country:US
Mailing Address - Phone:571-472-6720
Mailing Address - Fax:571-432-2970
Practice Address - Street 1:8260 WILLOW OAKS CORPORATE DR STE 350
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4527
Practice Address - Country:US
Practice Address - Phone:571-472-6720
Practice Address - Fax:571-432-2970
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174134367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife