Provider Demographics
NPI:1518184993
Name:ROUSH, STACY R (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:R
Last Name:ROUSH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 MONTMORENCY DR S
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8341
Mailing Address - Country:US
Mailing Address - Phone:614-404-4863
Mailing Address - Fax:
Practice Address - Street 1:637 MONTMORENCY DR S
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8341
Practice Address - Country:US
Practice Address - Phone:614-404-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN071281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse