Provider Demographics
NPI:1902981251
Name:STACEY, AMY MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:STACEY
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:UNIT 27502 BOX 16707
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09139
Mailing Address - Country:US
Mailing Address - Phone:0951-209-0490
Mailing Address - Fax:
Practice Address - Street 1:USAHC BAMBERG
Practice Address - Street 2:UNIT 27528
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09139
Practice Address - Country:US
Practice Address - Phone:095-130-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1394794081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse