Healthcare Provider Details

I. General information

NPI: 1316996366
Provider Name (Legal Business Name): LUCY M. STACY M.S.,R.D.,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

IV. Provider business mailing address

214 E 23RD ST
CHEYENNE WY
82001-3748
US

V. Phone/Fax

Practice location:
  • Phone: 307-432-6483
  • Fax: 307-633-7998
Mailing address:
  • Phone: 307-432-6483
  • Fax: 307-633-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: