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General NPI Number Information
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NPI Number | 1023824075
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Entity Type | Individual
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Provider Name | STACI ROARK BSN, RN, CA/CP SANE
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Gender | Female
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 602 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79415-3364
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Country | US
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Telephone | 806-775-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 602 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79415-3364
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Country | US
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Telephone | 806-775-9700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 1087531
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License Number State | TX
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