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NPI Code Detail

MEDICARE: MISS STACEY NELSON MSW, LSW

MEDICARE: MISS STACEY NELSON MSW, LSW
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
1104100000XSocial Worker9620083CO

General Provider Information

NPI Number : 1609942655
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS STACEY NELSON MSW, LSW
Provider Business Mailing Address
First Line : 6240 S MONROE DR
Second Line :
City : CENTENNIAL
State : CO
Zip : 80121-3121
Country : US
Telephone Number : 303-740-7784
Fax Number :
Provider Business Practice Location Address
First Line : 4371 E 72ND AVE
Second Line :
City : COMMERCE CITY
State : CO
Zip : 80022-1471
Country : US
Telephone Number : 303-853-3636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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