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NPI Code Detail

MEDICARE: STACEY NORTHCUTT RN

MEDICARE: STACEY NORTHCUTT RN
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
1163W00000XRegistered NurseRN444990CA

General Provider Information

NPI Number : 1184464778
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY NORTHCUTT RN
Provider Business Mailing Address
First Line : PO BOX 4473
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92605-4473
Country : US
Telephone Number : 714-469-0896
Fax Number :
Provider Business Practice Location Address
First Line : 12781 JOSEPHINE ST
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92841-4622
Country : US
Telephone Number : 657-251-0503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2024
Last Update Date : 05/30/2024

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