Provider Demographics
NPI:1154027464
Name:GRENELL, STACY L (RN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:GRENELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6356 CROCKER ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1047
Mailing Address - Country:US
Mailing Address - Phone:319-981-3329
Mailing Address - Fax:
Practice Address - Street 1:6356 CROCKER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1047
Practice Address - Country:US
Practice Address - Phone:319-981-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122739163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical