Provider Demographics
NPI:1609304898
Name:DELANEY, STACEY ANN (APN, CRNA)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:DELANEY
Suffix:
Gender:F
Credentials:APN, CRNA
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:STAAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CRNA
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:STE 8490
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-6161
Mailing Address - Fax:
Practice Address - Street 1:1 CAPITAL WAY
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2520
Practice Address - Country:US
Practice Address - Phone:800-637-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN615228367500000X
NJ26NR17847400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
116681OtherNBCRNA
NJ26NR17847400OtherRN