Provider Demographics
NPI:1861681777
Name:MANK, STACEY L (RN)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:MANK
Suffix:
Gender:F
Credentials:RN
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 130
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0130
Mailing Address - Country:US
Mailing Address - Phone:907-826-3433
Mailing Address - Fax:907-826-3435
Practice Address - Street 1:1800 CRAIG KLAWOCK HIGHWAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:AK
Practice Address - Zip Code:99921-0130
Practice Address - Country:US
Practice Address - Phone:907-826-3433
Practice Address - Fax:907-826-3435
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK23578163W00000X
AK812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily