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General NPI Number Information
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NPI Number | 1134760911
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Entity Type | Individual
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Provider Name | STACY LYNN CARGILL LPN
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Gender | Female
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 240 N C ST
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City | BUCKLEY
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State | WA
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Zip | 98321-8044
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Country | US
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Telephone | 360-829-6162
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Fax | 253-829-3391
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Provider Business Mailing Address
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Address Line | PO BOX 1976
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City | BUCKLEY
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State | WA
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Zip | 98321-1976
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Country | US
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Telephone | 360-829-6162
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Fax | 253-829-3391
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP00031720
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License Number State | WA
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