Provider Demographics
NPI:1124355003
Name:KRACHER, STACY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:KRACHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 PAOAKALANI AVE APT 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3703
Mailing Address - Country:US
Mailing Address - Phone:808-688-6947
Mailing Address - Fax:808-845-2018
Practice Address - Street 1:2100 N NIMITZ HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2218
Practice Address - Country:US
Practice Address - Phone:808-845-2018
Practice Address - Fax:808-845-3729
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI717163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult