Provider Demographics
NPI:1780482984
Name:MCMILLAN, STACEY
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 COVE PL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3705
Mailing Address - Country:US
Mailing Address - Phone:330-720-8393
Mailing Address - Fax:
Practice Address - Street 1:850 COVE PL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3705
Practice Address - Country:US
Practice Address - Phone:330-720-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide