Provider Demographics
NPI:1700542537
Name:ALLGOOD, STACI NICHOLE
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:NICHOLE
Last Name:ALLGOOD
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 1:2510 BROGDEN RD
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-9216
Mailing Address - Country:US
Mailing Address - Phone:919-559-7663
Mailing Address - Fax:
Practice Address - Street 1:2510 BROGDEN RD
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9216
Practice Address - Country:US
Practice Address - Phone:919-559-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC284045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse