Provider Demographics
NPI:1922475557
Name:HARRIS, STACY (STNA)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STNA
Mailing Address - Street 1:3459 SEABROOK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3243
Mailing Address - Country:US
Mailing Address - Phone:614-282-1511
Mailing Address - Fax:614-418-9100
Practice Address - Street 1:3459 SEABROOK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3243
Practice Address - Country:US
Practice Address - Phone:614-282-1511
Practice Address - Fax:614-418-9100
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4012189004113747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider