Provider Demographics
NPI:1902174675
Name:BARRETT, STACEY LEE (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 NORTGH JERUSALEM ROAD
Mailing Address - Street 2:NASSAU BOCES CCA
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-396-2900
Mailing Address - Fax:516-396-2990
Practice Address - Street 1:2250 NORTHJERUSALEM ROAD
Practice Address - Street 2:NASSAU BOCES CCA
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-396-2900
Practice Address - Fax:516-396-2990
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344228-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse