Provider Demographics
NPI:1003461856
Name:KROM, STACIE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:KROM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7062 ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-2957
Mailing Address - Country:US
Mailing Address - Phone:321-946-4541
Mailing Address - Fax:
Practice Address - Street 1:3 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-2303
Practice Address - Country:US
Practice Address - Phone:321-946-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277782-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse