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General NPI Number Information
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NPI Number | 1366642860
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Entity Type | Individual
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Provider Name | STACY M SPECK RD, RN, APN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE RM B501
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-5741
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Fax | 216-844-5710
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Provider Business Mailing Address
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Address Line | 1500 DETROIT AVE APT 618
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City | CLEVELAND
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State | OH
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Zip | 44113-2448
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Country | US
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Telephone | 419-564-2927
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209006587
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | .0032134
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License Number State | OH
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