Provider Demographics
NPI:1467138073
Name:PFANNENSTIEL, STACEY ANNE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANNE
Last Name:PFANNENSTIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23408 NIGHTSKY RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-5924
Mailing Address - Country:US
Mailing Address - Phone:619-402-4376
Mailing Address - Fax:
Practice Address - Street 1:23408 NIGHTSKY RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-5924
Practice Address - Country:US
Practice Address - Phone:619-402-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3081759OtherDRIVER LICENSE