Provider Demographics
NPI:1205206075
Name:SPURR, STACY KATHLEEN (NP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:KATHLEEN
Last Name:SPURR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:KATHLEEN
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 415
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:855-286-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00592700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner