Provider Demographics
NPI:1336244482
Name:REES, STACEY J (CNM)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:REES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MILES CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4047
Mailing Address - Country:US
Mailing Address - Phone:207-563-4700
Mailing Address - Fax:207-563-4019
Practice Address - Street 1:24 MILES CENTER WAY
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-4700
Practice Address - Fax:207-563-4019
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM142009367A00000X
NYF001033-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02548194Medicaid
NY68078OtherCIGNA PROVIDER #
NY1899648OtherGHI PROVIDER #
NYM1M183OtherBLUECROSS PROVIDER #
NY2397955OtherUNITED HC PROVIDER #
NYP3408914OtherOXFORD PROVIDER #