1841732393 NPI number — MS. STACEY ANN LAFAVE WARD QBHP

Table of content: MS. STACEY ANN LAFAVE WARD QBHP (NPI 1841732393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841732393 NPI number — MS. STACEY ANN LAFAVE WARD QBHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
STACEY
Provider Middle Name:
ANN LAFAVE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
QBHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841732393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
358 KILLARNEY BEACH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706-1185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-737-3575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3253 CONGRESS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48602-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-793-4790
Provider Business Practice Location Address Fax Number:
989-793-1641
Provider Enumeration Date:
11/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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