Provider Demographics
NPI:1972309672
Name:COOLEY, STACY JO
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:COOLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 SAINT PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1308
Mailing Address - Country:US
Mailing Address - Phone:308-379-8294
Mailing Address - Fax:
Practice Address - Street 1:2627 SAINT PATRICK AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1308
Practice Address - Country:US
Practice Address - Phone:308-379-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider