Provider Demographics
NPI:1750674792
Name:COSS, STACY R (LPN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:COSS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 THREE TOWERS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43727-9629
Mailing Address - Country:US
Mailing Address - Phone:740-221-3299
Mailing Address - Fax:
Practice Address - Street 1:2521 THREE TOWERS RD
Practice Address - Street 2:
Practice Address - City:CHANDLERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43727-9629
Practice Address - Country:US
Practice Address - Phone:740-221-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 124273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse