Provider Demographics
NPI:1790116002
Name:BARRETT, STACIE
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RHOMBOID PL
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2635
Mailing Address - Country:US
Mailing Address - Phone:803-442-6330
Mailing Address - Fax:
Practice Address - Street 1:201 RHOMBOID PL
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:SC
Practice Address - Zip Code:29841-2635
Practice Address - Country:US
Practice Address - Phone:803-442-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC214152163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator