Provider Demographics
NPI:1265754162
Name:MACFARLANE, STACEY L (CPNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:MACFARLANE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:BEDNARZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 E. KENTUCKY AVE.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-756-0101
Mailing Address - Fax:
Practice Address - Street 1:4900 E. KENTUCKY AVE. CHERRY CREEK PEDIATRICS
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-756-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10170363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics