Provider Demographics
NPI:1780314898
Name:MCGREGOR, STACEY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COVEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:EAST FALLOWFIELD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4761
Mailing Address - Country:US
Mailing Address - Phone:609-775-5676
Mailing Address - Fax:
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:484-565-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN632938367500000X
DEL1-0055539367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered