Provider Demographics
NPI:1386268951
Name:MUNRO, STACY M (RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:MUNRO
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:M
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:6991 BALBOA AVE RM 70
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3447
Mailing Address - Country:US
Mailing Address - Phone:858-496-8232
Mailing Address - Fax:858-496-8234
Practice Address - Street 1:6991 BALBOA AVE RM 70
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3447
Practice Address - Country:US
Practice Address - Phone:858-496-8232
Practice Address - Fax:858-496-8234
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse