Provider Demographics
NPI:1467713727
Name:WARTHER, STACEY JO (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:JO
Last Name:WARTHER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CHISELED STONE RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8655
Mailing Address - Country:US
Mailing Address - Phone:410-491-0337
Mailing Address - Fax:
Practice Address - Street 1:324 CHISELED STONE RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-8655
Practice Address - Country:US
Practice Address - Phone:410-491-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR086989163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse