Provider Demographics
NPI:1477263507
Name:MYERS, STACHIA LEIGH (DON RN)
Entity Type:Individual
Prefix:
First Name:STACHIA
Middle Name:LEIGH
Last Name:MYERS
Suffix:
Gender:F
Credentials:DON RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-2415
Mailing Address - Country:US
Mailing Address - Phone:765-621-4598
Mailing Address - Fax:
Practice Address - Street 1:524 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:IN
Practice Address - Zip Code:46017-1514
Practice Address - Country:US
Practice Address - Phone:765-378-0213
Practice Address - Fax:765-378-7471
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28222938A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse