Provider Demographics
NPI:1790529907
Name:STACEY, JADE MONICA-MARIE (DEM TM)
Entity type:Individual
Prefix:MRS
First Name:JADE
Middle Name:MONICA-MARIE
Last Name:STACEY
Suffix:
Gender:F
Credentials:DEM TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:MANDAREE
Mailing Address - State:ND
Mailing Address - Zip Code:58757-0576
Mailing Address - Country:US
Mailing Address - Phone:406-690-5694
Mailing Address - Fax:406-303-4063
Practice Address - Street 1:PO BOX 576
Practice Address - Street 2:
Practice Address - City:MANDAREE
Practice Address - State:ND
Practice Address - Zip Code:58757-0576
Practice Address - Country:US
Practice Address - Phone:406-690-5694
Practice Address - Fax:406-303-4063
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay