Provider Demographics
NPI:1881409928
Name:DEVERTEUIL - DIXON, STACEY NATOYA (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:NATOYA
Last Name:DEVERTEUIL - DIXON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17224 133RD AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3903
Mailing Address - Country:US
Mailing Address - Phone:646-919-7396
Mailing Address - Fax:
Practice Address - Street 1:17224 133RD AVE APT 12A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3903
Practice Address - Country:US
Practice Address - Phone:646-919-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY652697-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse