Provider Demographics
NPI:1295063014
Name:WHITE, STACEY LORENA (RN)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LORENA
Last Name:WHITE
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 1:201-09 E MERRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580
Mailing Address - Country:US
Mailing Address - Phone:516-652-5532
Mailing Address - Fax:516-887-6500
Practice Address - Street 1:933 DERRICK ADKINS LANE
Practice Address - Street 2:
Practice Address - City:WEST HEMSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552
Practice Address - Country:US
Practice Address - Phone:516-652-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399433-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health