Provider Demographics
NPI:1235496407
Name:MCINTYRE, STACY LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:CRNA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3900 CAPITOL MALL DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8654
Mailing Address - Country:US
Mailing Address - Phone:954-838-2588
Mailing Address - Fax:954-514-3979
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3300
Practice Address - Fax:253-596-3301
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60270648367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered