MEDICARE: STACY RENEE PAULEY RN, BSN, CHPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH1000X	Hospice Registered Nurse	041466728	IL

General Provider Information

NPI Number	:	1033056833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY RENEE PAULEY RN, BSN, CHPN

Provider Business Mailing Address
First Line	:	8613 BYRON HILLS DR
Second Line	:
City	:	BYRON
State	:	IL
Zip	:	61010-9791
Country	:	US
Telephone Number	:	815-262-3808
Fax Number	:	815-262-3808

Provider Business Practice Location Address
First Line	:	4751 HARRISON AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-7929
Country	:	US
Telephone Number	:	815-398-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2026
Last Update Date	:	04/30/2026

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