Provider Demographics
NPI:1497184998
Name:PIERSON, STACEY LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:PIERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11059 E. BETHANY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:303-617-2397
Practice Address - Street 1:11059 E. BETHANY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2397
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129892163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO129892OtherREGISTERED NURSE