Provider Demographics
NPI:1376810861
Name:ALLEGER, STACIE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:ALLEGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEST MEADOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228
Mailing Address - Country:US
Mailing Address - Phone:515-371-3980
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP55079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse