Individual
DEBRA STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSNE PMHNP ANP CDE
Contact information
Practice address
5820 MAIN ST STE 406, WILLIAMSVILLE, NY 14221-5734
(716) 544-0996
(716) 544-0997
Mailing address
3843 UNION RD # 15-127, BUFFALO, NY 14225-4256
(716) 544-0996
(716) 544-0997
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
486617-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401660
NY
Other
Enumeration date
06/25/2010
Last updated
12/11/2016
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