Provider Demographics
NPI:1972048270
Name:DIPASQUALE, STACIE (RN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:DIPASQUALE
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 1:4759 BROMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2963
Mailing Address - Country:US
Mailing Address - Phone:716-864-5776
Mailing Address - Fax:716-299-2860
Practice Address - Street 1:4759 BROMPTON DR
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2963
Practice Address - Country:US
Practice Address - Phone:716-864-5776
Practice Address - Fax:716-299-2860
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse