Provider Demographics
NPI:1902376874
Name:STALEY, LUCINDA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:JEAN
Last Name:STALEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-0070
Mailing Address - Country:US
Mailing Address - Phone:304-272-5116
Mailing Address - Fax:
Practice Address - Street 1:212 N COURT ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-1141
Practice Address - Country:US
Practice Address - Phone:304-272-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV88828163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool