Healthcare Provider Details

I. General information

NPI: 1407110810
Provider Name (Legal Business Name): STACEY ANNE VACCHIANO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY ANNE WISNIEWSKI

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

PO BOX 858 MC A410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8401
  • Fax: 717-531-0647
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP006187B
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP006187B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: