Healthcare Provider Details

I. General information

NPI: 1902981251
Provider Name (Legal Business Name): AMY MARIE STACEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC BAMBERG UNIT 27528
APO AE NY
09139
US

IV. Provider business mailing address

UNIT 27502 BOX 16707
APO AE
09139
US

V. Phone/Fax

Practice location:
  • Phone: 95-130-0917
  • Fax:
Mailing address:
  • Phone: 09512090490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1394794081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: