Provider Demographics
NPI:1497981880
Name:DUNN, STACEY L (CSA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:DUNN
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:57 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4101
Mailing Address - Country:US
Mailing Address - Phone:413-297-0237
Mailing Address - Fax:
Practice Address - Street 1:57 ALTON ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4101
Practice Address - Country:US
Practice Address - Phone:413-297-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant