Healthcare Provider Details

I. General information

NPI: 1215862289
Provider Name (Legal Business Name): STACEY K PASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11838 E 114TH PL
COMMERCE CITY CO
80640-9297
US

IV. Provider business mailing address

11838 E 114TH PL
COMMERCE CITY CO
80640-9297
US

V. Phone/Fax

Practice location:
  • Phone: 303-931-1469
  • Fax:
Mailing address:
  • Phone: 303-931-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: