Provider Demographics
NPI:1356686570
Name:D'AQUILA, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:D'AQUILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 CLARKSON CT
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2257
Mailing Address - Country:US
Mailing Address - Phone:314-616-5849
Mailing Address - Fax:
Practice Address - Street 1:850 COUNTRY MANOR LN
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6651
Practice Address - Country:US
Practice Address - Phone:314-434-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025320251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care