Provider Demographics
NPI:1255023198
Name:GREER, STACY L (RN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:GREER
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 1:830 CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-2835
Mailing Address - Country:US
Mailing Address - Phone:618-759-1958
Mailing Address - Fax:
Practice Address - Street 1:830 CHAPMAN LN
Practice Address - Street 2:
Practice Address - City:GOREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62939-2835
Practice Address - Country:US
Practice Address - Phone:618-759-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041432464163WA2000X
KY1145624163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator