Provider Demographics
NPI:1245631738
Name:WEBER, STACY MARIE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:LUTTRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1907 CYPRESS CREEK ROAD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-294-2565
Mailing Address - Fax:
Practice Address - Street 1:1907 CYPRESS CREEK ROAD
Practice Address - Street 2:SUITE #108
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-294-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPI26575367500000X
TX862299367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered