Healthcare Provider Details

I. General information

NPI: 1033056833
Provider Name (Legal Business Name): STACY RENEE PAULEY RN, BSN, CHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 HARRISON AVE
ROCKFORD IL
61108-7929
US

IV. Provider business mailing address

8613 BYRON HILLS DR
BYRON IL
61010-9791
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-0500
  • Fax:
Mailing address:
  • Phone: 815-262-3808
  • Fax: 815-262-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number041466728
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: