Provider Demographics
NPI:1467207043
Name:VANT HOF, STACEY LYNNE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:VANT HOF
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 1:22733 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-9658
Mailing Address - Country:US
Mailing Address - Phone:937-672-5326
Mailing Address - Fax:
Practice Address - Street 1:22733 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-9658
Practice Address - Country:US
Practice Address - Phone:937-672-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH404534376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker