Provider Demographics
NPI:1225231608
Name:DESHON, STACIA LEE
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:LEE
Last Name:DESHON
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 1:8516 WILLOWOOD CIR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4471
Mailing Address - Country:US
Mailing Address - Phone:406-338-6369
Mailing Address - Fax:
Practice Address - Street 1:BLACKFEET COMMUNITY HOSPITAL
Practice Address - Street 2:760 HOSPITAL CIRCLE
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-0760
Practice Address - Country:US
Practice Address - Phone:406-338-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00099859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse