Healthcare Provider Details

I. General information

NPI: 1891608295
Provider Name (Legal Business Name): STACI C STARK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACI HALLMAN

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY BLDG 727
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY BLDG 727
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7513
  • Fax:
Mailing address:
  • Phone: 916-843-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95130169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: