Provider Demographics
NPI:1407893134
Name:LAMAR, STACEY (DRPH, RN, CNM,)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:LAMAR
Suffix:
Gender:F
Credentials:DRPH, RN, CNM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SLATE HILL DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5509
Mailing Address - Country:US
Mailing Address - Phone:845-546-7134
Mailing Address - Fax:845-849-3554
Practice Address - Street 1:4415 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1550
Practice Address - Country:US
Practice Address - Phone:845-546-7134
Practice Address - Fax:845-849-3554
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416419-1163W00000X
NYF000968176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMGM271Medicare UPIN
NYMGM2720581Medicare PIN