Provider Demographics
NPI:1124802848
Name:HILL, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 MICHIGAN AVE APT A207
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3121
Mailing Address - Country:US
Mailing Address - Phone:440-344-6510
Mailing Address - Fax:
Practice Address - Street 1:2158 MICHIGAN AVE APT A207
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3121
Practice Address - Country:US
Practice Address - Phone:440-344-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker