Provider Demographics
NPI:1134611924
Name:SASYNIUK, STACEY LYNN (RN)
Entity type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:LYNN
Last Name:SASYNIUK
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 1:33195 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:BC
Mailing Address - Zip Code:V2V 4Z4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8014
Practice Address - Country:US
Practice Address - Phone:360-676-2020
Practice Address - Fax:360-676-2210
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60617685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse