Provider Demographics
NPI:1942800248
Name:FINNEMAN, STACEY ANN
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:FINNEMAN
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 1:7674 79TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58562-9208
Mailing Address - Country:US
Mailing Address - Phone:701-824-2775
Mailing Address - Fax:
Practice Address - Street 1:207 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533-7233
Practice Address - Country:US
Practice Address - Phone:701-622-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant