Provider Demographics
NPI:1114732286
Name:DRAKE, STACEY (CNA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1001
Mailing Address - Country:US
Mailing Address - Phone:402-362-1444
Mailing Address - Fax:402-363-6623
Practice Address - Street 1:2319 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1001
Practice Address - Country:US
Practice Address - Phone:402-362-1444
Practice Address - Fax:402-363-6623
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 3747P1801X
NE104822376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant