Provider Demographics
NPI:1942932421
Name:BABCOCK, STACEY J (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 PROSPECT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4230
Mailing Address - Country:US
Mailing Address - Phone:860-999-4431
Mailing Address - Fax:
Practice Address - Street 1:660 PROSPECT AVE STE 100
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4230
Practice Address - Country:US
Practice Address - Phone:860-999-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT114001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse