Provider Demographics
NPI:1093914335
Name:HAHN, STACEY JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:JEAN
Last Name:HAHN
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 1:11557 STATE ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033-3326
Mailing Address - Country:US
Mailing Address - Phone:315-626-6812
Mailing Address - Fax:
Practice Address - Street 1:11557 STATE ROUTE 34
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033-3326
Practice Address - Country:US
Practice Address - Phone:315-626-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 285846164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse