Provider Demographics
NPI:1962890897
Name:TONEY, STACEY JUNE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:JUNE
Last Name:TONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 BALDWIN AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4161
Mailing Address - Country:US
Mailing Address - Phone:330-371-7601
Mailing Address - Fax:
Practice Address - Street 1:2923 BALDWIN AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4161
Practice Address - Country:US
Practice Address - Phone:330-371-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401115150710376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide