Provider Demographics
NPI:1861253577
Name:STACY, LINDSEY MAYE
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MAYE
Last Name:STACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 SAGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1408
Mailing Address - Country:US
Mailing Address - Phone:619-253-1423
Mailing Address - Fax:
Practice Address - Street 1:16620 SAGEWOOD LN
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-1408
Practice Address - Country:US
Practice Address - Phone:619-253-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY6693800OtherDRIVER LICENSE