Provider Demographics
NPI:1639524762
Name:DREW, STACY (PA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SANDHURST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1623
Mailing Address - Country:US
Mailing Address - Phone:919-475-5389
Mailing Address - Fax:
Practice Address - Street 1:285 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUNN
Practice Address - State:NC
Practice Address - Zip Code:27508-7258
Practice Address - Country:US
Practice Address - Phone:919-496-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant