Provider Demographics
NPI:1629833462
Name:GALBRAITH, STACY LEA
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEA
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1442
Mailing Address - Country:US
Mailing Address - Phone:419-583-6944
Mailing Address - Fax:
Practice Address - Street 1:210 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1442
Practice Address - Country:US
Practice Address - Phone:419-583-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant