Provider Demographics
NPI:1447072624
Name:SWEET, STACEY MICHELE (LPN)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MICHELE
Last Name:SWEET
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MOUNTAIN VIEW ESTS
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-9770
Mailing Address - Country:US
Mailing Address - Phone:304-640-3830
Mailing Address - Fax:
Practice Address - Street 1:1022 WAL ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2101
Practice Address - Country:US
Practice Address - Phone:304-872-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31935164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse