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General NPI Number Information
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NPI Number | 1275844136
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Entity Type | Individual
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Provider Name | DEBRA STACEY MSNE PMHNP ANP CDE
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Gender | Female
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 12/11/2016
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Provider Practice Location Address
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Address Line | 5820 MAIN ST STE 406
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5734
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Country | US
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Telephone | 716-544-0996
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Fax | 716-544-0997
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Provider Business Mailing Address
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Address Line | 3843 UNION RD # 15-127
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City | BUFFALO
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State | NY
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Zip | 14225-4256
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Country | US
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Telephone | 716-544-0996
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Fax | 716-544-0997
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 486617-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 401660
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License Number State | NY
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