Provider Demographics
NPI:1932795176
Name:MONNAT, STACEY (NP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MONNAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MCINTOSH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3438
Mailing Address - Country:US
Mailing Address - Phone:585-766-0668
Mailing Address - Fax:
Practice Address - Street 1:5719 WIDEWATERS PKWY STE 2
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1877
Practice Address - Country:US
Practice Address - Phone:315-544-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645931-01163W00000X
NYF346076-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse