Provider Demographics
NPI:1114130549
Name:DONALDSON, STACY LYNN (STNA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29629 CHERRYCREST DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8601
Mailing Address - Country:US
Mailing Address - Phone:740-385-6655
Mailing Address - Fax:
Practice Address - Street 1:29629 CHERRYCREST DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8601
Practice Address - Country:US
Practice Address - Phone:740-385-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400266150703OtherSTATE TESTED NURSING ASSI