Provider Demographics
NPI:1861897456
Name:TAYLOR, STACEY MARIE (CRNP, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNP, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2512
Mailing Address - Country:US
Mailing Address - Phone:570-441-6262
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18765-0999
Practice Address - Country:US
Practice Address - Phone:570-441-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-26
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANOT AVAILABLE363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily