Provider Demographics
NPI:1861604712
Name:STOGNER, CLARA RUIZ (CPNP-PC)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:RUIZ
Last Name:STOGNER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:735 GLYNN ST S
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2049
Mailing Address - Country:US
Mailing Address - Phone:770-461-4126
Mailing Address - Fax:770-461-5993
Practice Address - Street 1:735 GLYNN ST S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2049
Practice Address - Country:US
Practice Address - Phone:770-461-4126
Practice Address - Fax:770-461-5993
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142052363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics