Provider Demographics
NPI:1003679721
Name:STACHO, AMY ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELAINE
Last Name:STACHO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CREOLA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8703
Mailing Address - Country:US
Mailing Address - Phone:843-767-5905
Mailing Address - Fax:
Practice Address - Street 1:3300 CREOLA RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8703
Practice Address - Country:US
Practice Address - Phone:843-767-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC273536163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool