Provider Demographics
NPI:1184854051
Name:KANCE, STACEY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:KANCE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-9275
Mailing Address - Country:US
Mailing Address - Phone:954-290-3656
Mailing Address - Fax:
Practice Address - Street 1:291 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-9275
Practice Address - Country:US
Practice Address - Phone:954-290-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003930133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered