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General NPI Number Information
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NPI Number | 1295132058
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Entity Type | Organization
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Legal Business Name | STACIE DEE LLC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 525 E 72ND ST APARTMENT 35B
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City | NEW YORK
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State | NY
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Zip | 10021-9601
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Country | US
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Telephone | 860-604-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E 72ND ST APARTMENT 35B
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City | NEW YORK
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State | NY
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Zip | 10021-9601
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Country | US
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Telephone | 860-604-8585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACIE A DEE
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Credential | MSN
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Telephone | 860-604-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401771-1
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License Number State | NY
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