Provider Demographics
NPI:1407511975
Name:YEE, STACEY LYN (LPN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYN
Last Name:YEE
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 1:904 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2628
Mailing Address - Country:US
Mailing Address - Phone:607-398-4333
Mailing Address - Fax:
Practice Address - Street 1:904 S PINE ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2628
Practice Address - Country:US
Practice Address - Phone:607-398-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271353164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse