Provider Demographics
NPI:1356977276
Name:DUBOIS, STACI L
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 S COUNTY ROAD 1213
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-7806
Mailing Address - Country:US
Mailing Address - Phone:318-471-1250
Mailing Address - Fax:
Practice Address - Street 1:9915 S COUNTY ROAD 1213
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-7806
Practice Address - Country:US
Practice Address - Phone:318-471-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX979751163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse