Provider Demographics
NPI:1558415794
Name:BIRNER, STACEY (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BIRNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TUNXIS RD
Mailing Address - Street 2:
Mailing Address - City:TARIFFVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06081-9619
Mailing Address - Country:US
Mailing Address - Phone:860-408-1278
Mailing Address - Fax:
Practice Address - Street 1:184 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4252
Practice Address - Country:US
Practice Address - Phone:860-688-7926
Practice Address - Fax:860-687-1798
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT072221163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse