Healthcare Provider Details

I. General information

NPI: 1316077316
Provider Name (Legal Business Name): STACY LEE RIHALY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8445 MUNSON RD
MENTOR OH
44060-2410
US

IV. Provider business mailing address

56 SIVON DR
PAINESVILLE OH
44077-4966
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-1700
  • Fax:
Mailing address:
  • Phone: 440-354-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number290227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: