Provider Demographics
NPI:1962250175
Name:STACER, REBECCA YVONNE (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:YVONNE
Last Name:STACER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2353
Mailing Address - Country:US
Mailing Address - Phone:440-650-8879
Mailing Address - Fax:
Practice Address - Street 1:2820 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2353
Practice Address - Country:US
Practice Address - Phone:440-650-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.405278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse