Provider Demographics
NPI:1598164345
Name:WASHINGTON, STACY (RN)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:WASHINGTON
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 1:2811 EAGLE CREST LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8093
Mailing Address - Country:US
Mailing Address - Phone:910-574-7882
Mailing Address - Fax:
Practice Address - Street 1:201 S MCPHERSON CHURCH RD STE 228
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4995
Practice Address - Country:US
Practice Address - Phone:910-429-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222305163WG0000X
NC11794163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)