Provider Demographics
NPI:1285283895
Name:TOWNSEND, STACY ANNE (CRNA)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANNE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 W WHITE OAK ST
Mailing Address - Street 2:UNIT D
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88242
Mailing Address - Country:US
Mailing Address - Phone:631-294-2917
Mailing Address - Fax:
Practice Address - Street 1:2200 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7831
Practice Address - Country:US
Practice Address - Phone:928-537-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591530163W00000X
NY119589367500000X
AZ315337367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse