Provider Demographics
NPI:1407883002
Name:HANRAHAN, STACEY ANN (BSN, MN, ARNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:HANRAHAN
Suffix:
Gender:F
Credentials:BSN, MN, ARNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 GOETHALS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3552
Mailing Address - Country:US
Mailing Address - Phone:509-943-3196
Mailing Address - Fax:509-946-0455
Practice Address - Street 1:945 GOETHALS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3552
Practice Address - Country:US
Practice Address - Phone:509-943-3196
Practice Address - Fax:509-946-0455
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005387363LF0000X
WARN00119966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS93699Medicare UPIN