Provider Demographics
NPI:1023597812
Name:CRILL, STACY LYNNAE (DNP, CPNP-PC, PMHS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNNAE
Last Name:CRILL
Suffix:
Gender:F
Credentials:DNP, CPNP-PC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-1420
Mailing Address - Country:US
Mailing Address - Phone:641-622-6902
Mailing Address - Fax:641-622-6507
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-1420
Practice Address - Country:US
Practice Address - Phone:641-622-6902
Practice Address - Fax:641-622-6507
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC109265363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics