Provider Demographics
NPI:1376977561
Name:COLLIER, STACEY ANN DUBYNA (R N)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN DUBYNA
Last Name:COLLIER
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 MAIDEN CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2940
Mailing Address - Country:US
Mailing Address - Phone:440-570-6542
Mailing Address - Fax:
Practice Address - Street 1:4227 MAIDEN CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2940
Practice Address - Country:US
Practice Address - Phone:440-570-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH384081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse