Healthcare Provider Details

I. General information

NPI: 1063569879
Provider Name (Legal Business Name): STACEY LYNN POZNANSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY LYNN BRAND DO

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

9387 PARAGON MILLS LN
CENTERVILLE OH
45458-4185
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8839
  • Fax:
Mailing address:
  • Phone: 608-770-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51684
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number009855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: