Provider Demographics
NPI:1063682953
Name:BROWN, STACEY LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:BROWN
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 1:146 E 100 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4602
Mailing Address - Country:US
Mailing Address - Phone:435-789-3865
Mailing Address - Fax:435-789-3895
Practice Address - Street 1:7852 W 600 N
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:UT
Practice Address - Zip Code:84325-9706
Practice Address - Country:US
Practice Address - Phone:435-789-3865
Practice Address - Fax:435-789-3895
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6164700-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse