Provider Demographics
NPI:1801696745
Name:GLASS, STACEY ANNE (RN, BSN, HWNC-BC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANNE
Last Name:GLASS
Suffix:
Gender:
Credentials:RN, BSN, HWNC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTHCREST DR # 294
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2315
Mailing Address - Country:US
Mailing Address - Phone:530-488-0250
Mailing Address - Fax:
Practice Address - Street 1:900 NORTHCREST DR # 294
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2315
Practice Address - Country:US
Practice Address - Phone:530-488-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95134873163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice