Provider Demographics
NPI:1104189232
Name:STACEY, LAUREL SUSAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:SUSAN
Last Name:STACEY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:57 WHITE OWL LN
Mailing Address - Street 2:PO BOX 1828
Mailing Address - City:CASHIERS
Mailing Address - State:NC
Mailing Address - Zip Code:28717-4514
Mailing Address - Country:US
Mailing Address - Phone:828-743-2491
Mailing Address - Fax:828-743-3060
Practice Address - Street 1:57 WHITE OWL LN
Practice Address - Street 2:
Practice Address - City:CASHIERS
Practice Address - State:NC
Practice Address - Zip Code:28717-4514
Practice Address - Country:US
Practice Address - Phone:828-743-2491
Practice Address - Fax:828-743-3060
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant