Provider Demographics
NPI:1285681502
Name:HUFF, STACIE JO (CRNP, PMHS)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:JO
Last Name:HUFF
Suffix:
Gender:F
Credentials:CRNP, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-1132
Mailing Address - Country:US
Mailing Address - Phone:330-453-3386
Mailing Address - Fax:330-453-2362
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-453-3386
Practice Address - Fax:330-453-2362
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07419363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437652Medicaid
NP15071Medicare ID - Type Unspecified
OHQ10575Medicare UPIN