Provider Demographics
NPI:1457186074
Name:ALESHIRE, STACY A
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:ALESHIRE
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 1:51922 MUD RUN RD
Mailing Address - Street 2:
Mailing Address - City:SARAHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43779-9712
Mailing Address - Country:US
Mailing Address - Phone:740-241-0575
Mailing Address - Fax:
Practice Address - Street 1:51922 MUD RUN RD
Practice Address - Street 2:
Practice Address - City:SARAHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43779-9712
Practice Address - Country:US
Practice Address - Phone:740-241-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN120657MEDS-IV164W00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No164W00000XNursing Service ProvidersLicensed Practical Nurse