Provider Demographics
NPI:1619906864
Name:GILROY, STACIE A
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:A
Last Name:GILROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:A
Other - Last Name:SPIEHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:249 OLSON DRIVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2974
Mailing Address - Country:US
Mailing Address - Phone:402-991-2200
Mailing Address - Fax:402-991-2242
Practice Address - Street 1:249 OLSON DRIVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2974
Practice Address - Country:US
Practice Address - Phone:402-991-2200
Practice Address - Fax:402-991-2242
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
470834610OtherTAX IDENIFICATION NUMBER
470834610OtherTAX IDENIFICATION NUMBER