Provider Demographics
NPI:1639326143
Name:SPAHN, STACEY LEA (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LEA
Last Name:SPAHN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 ROSEFINCH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4920
Mailing Address - Country:US
Mailing Address - Phone:715-347-5654
Mailing Address - Fax:
Practice Address - Street 1:1219 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1708
Practice Address - Country:US
Practice Address - Phone:702-384-1110
Practice Address - Fax:702-320-1639
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128550-030163W00000X
NV852688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35061700Medicaid