Individual
STACEY LYNN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 779-3366
Mailing address
77 W FOREST AVE STE 117, FLAGSTAFF, AZ 86001-1482
(928) 773-2505
(928) 773-2504
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
078032
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
295431
—
AZ
Enumeration date
11/14/2007
Last updated
06/19/2025
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