Provider Demographics
NPI:1639483357
Name:ALCORN, STACIE LYNN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:ALCORN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CLIFFTON DR
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4411
Mailing Address - Country:US
Mailing Address - Phone:937-216-0904
Mailing Address - Fax:
Practice Address - Street 1:113 CLIFFTON DR
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4411
Practice Address - Country:US
Practice Address - Phone:937-216-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN255445163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology