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NPI Code Detail

MEDICARE: STACY LEE DRAKE

MEDICARE: STACY LEE DRAKE
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
1171M00000XCase Manager/Care CoordinatorCPSS-329NE

General Provider Information

NPI Number : 1417795360
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY LEE DRAKE
Provider Business Mailing Address
First Line : 1804 S EDDY ST
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-7114
Country : US
Telephone Number : 308-336-3590
Fax Number :
Provider Business Practice Location Address
First Line : 1804 S EDDY ST
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68801-7114
Country : US
Telephone Number : 308-663-3590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2024
Last Update Date : 03/05/2026

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Directions to “ STACY LEE DRAKE ” Practice Location

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