Provider Demographics
NPI:1972954758
Name:WILLIAMS, STACY (RN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1600 SPECHT POINT
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-493-7733
Mailing Address - Fax:970-493-8745
Practice Address - Street 1:1600 SPECHT POINT
Practice Address - Street 2:SUITE 127
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-493-7733
Practice Address - Fax:970-493-8745
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN0992571-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner