Provider Demographics
NPI:1538238654
Name:LAY, STACI (LMP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:LAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1701
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-1701
Mailing Address - Country:US
Mailing Address - Phone:253-740-7829
Mailing Address - Fax:360-879-1115
Practice Address - Street 1:21135 SR 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8457
Practice Address - Country:US
Practice Address - Phone:253-740-7829
Practice Address - Fax:360-879-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018332175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601736801OtherUBI