Healthcare Provider Details

I. General information

NPI: 1598445561
Provider Name (Legal Business Name): STACEY LYNN CASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N MAIN ST
ALTURAS CA
96101-3457
US

IV. Provider business mailing address

441 N MAIN ST
ALTURAS CA
96101-3457
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-6312
  • Fax: 530-233-6339
Mailing address:
  • Phone: 530-233-6312
  • Fax: 530-233-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-LHBTEV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: