Provider Demographics
NPI:1821416934
Name:PEREZ, STACEY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:10820 NW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2925
Mailing Address - Country:US
Mailing Address - Phone:405-795-9309
Mailing Address - Fax:
Practice Address - Street 1:10820 NW 38TH TER
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2925
Practice Address - Country:US
Practice Address - Phone:405-795-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0068749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse