Provider Demographics
NPI:1528364460
Name:LESUEUR, STACY (DNP, FNP-C, CRNA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LESUEUR
Suffix:
Gender:F
Credentials:DNP, FNP-C, CRNA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8042 S HUNTERS MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6289
Mailing Address - Country:US
Mailing Address - Phone:801-350-1331
Mailing Address - Fax:
Practice Address - Street 1:7535 S UNION PARK AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3043
Practice Address - Country:US
Practice Address - Phone:801-350-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5188629-4405363L00000X
UT5188629-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner