Healthcare Provider Details

I. General information

NPI: 1558415794
Provider Name (Legal Business Name): STACEY BIRNER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 DEERFIELD RD
WINDSOR CT
06095-4252
US

IV. Provider business mailing address

11 TUNXIS RD
TARIFFVILLE CT
06081-9619
US

V. Phone/Fax

Practice location:
  • Phone: 860-688-7926
  • Fax: 860-687-1798
Mailing address:
  • Phone: 860-408-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number072221
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: