Healthcare Provider Details

I. General information

NPI: 1366925109
Provider Name (Legal Business Name): LACEY LEIGH ANN STALNAKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LACEY LEIGH ANN DRIVER

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1757
US

IV. Provider business mailing address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1757
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-8131
  • Fax:
Mailing address:
  • Phone: 614-445-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN.378894
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: