Healthcare Provider Details

I. General information

NPI: 1184538209
Provider Name (Legal Business Name): STACEY NICOLE CONYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MORRIS ST # 102B
BATH NY
14810-1412
US

IV. Provider business mailing address

211 W MORRIS ST # 102B
BATH NY
14810-1412
US

V. Phone/Fax

Practice location:
  • Phone: 607-794-0197
  • Fax:
Mailing address:
  • Phone: 607-794-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number300223-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: