Provider Demographics
NPI:1760498216
Name:HORSLEY, STACEY LYNNE (RNFA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:HORSLEY
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HEGER WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7121
Mailing Address - Country:US
Mailing Address - Phone:916-733-8524
Mailing Address - Fax:916-733-8214
Practice Address - Street 1:2201 HEGER WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7121
Practice Address - Country:US
Practice Address - Phone:916-733-8524
Practice Address - Fax:916-733-8214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80Medicare UPIN