Provider Demographics
NPI:1902475908
Name:SCHRANER, STACEY (BS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SCHRANER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-2004
Mailing Address - Country:US
Mailing Address - Phone:157-574-0568
Mailing Address - Fax:
Practice Address - Street 1:900 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-6600
Practice Address - Country:US
Practice Address - Phone:575-740-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty