Provider Demographics
NPI:1578234860
Name:STRONG, STACIE LEE
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LEE
Last Name:STRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:LEE
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3275
Mailing Address - Country:US
Mailing Address - Phone:402-370-4100
Mailing Address - Fax:402-370-4101
Practice Address - Street 1:305 N 37TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3275
Practice Address - Country:US
Practice Address - Phone:402-370-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE69359363LF0000X
NE113835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEXXXXXX64400Medicaid