Provider Demographics
NPI:1043048820
Name:LUZADER, STACEY ALLIE (APRN-CNM)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ALLIE
Last Name:LUZADER
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 STATE ROUTE 113 E
Mailing Address - Street 2:
Mailing Address - City:BERLIN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44814-9440
Mailing Address - Country:US
Mailing Address - Phone:440-521-6827
Mailing Address - Fax:
Practice Address - Street 1:51 PARK WEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4215
Practice Address - Country:US
Practice Address - Phone:330-375-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.424109163W00000X
OHAPRN.CNM.0019609176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse