Healthcare Provider Details

I. General information

NPI: 1235600826
Provider Name (Legal Business Name): STACEY LEIGH SUNDLING RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACEY LEIGH FIELD RN, PHN

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6598 DAYLILY DR
CARLSBAD CA
92011-1266
US

IV. Provider business mailing address

3609 OCEAN RANCH BLVD SUITE 104
OCEANSIDE CA
92056
US

V. Phone/Fax

Practice location:
  • Phone: 858-705-2804
  • Fax:
Mailing address:
  • Phone: 760-967-4401
  • Fax: 760-967-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95022242
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95022242
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95022242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: