Provider Demographics
NPI:1295126068
Name:NUNNE, STACY BLAKE (MA, LAMFT, RN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:BLAKE
Last Name:NUNNE
Suffix:
Gender:F
Credentials:MA, LAMFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-0892
Mailing Address - Country:US
Mailing Address - Phone:952-215-5208
Mailing Address - Fax:888-974-6441
Practice Address - Street 1:600 W 78TH ST STE 10B
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9585
Practice Address - Country:US
Practice Address - Phone:952-215-5208
Practice Address - Fax:888-974-6441
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2803106H00000X
MNR-110685-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse