Provider Demographics
NPI:1447652318
Name:DRAHUSCHAK, STACEY (CNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:DRAHUSCHAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:BRATSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6770 MAYFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-312-2229
Mailing Address - Fax:440-312-7725
Practice Address - Street 1:6770 MAYFIELD ROAD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-312-2229
Practice Address - Fax:440-312-7725
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN327805163W00000X
OH16518NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110951Medicaid
OH0110951Medicaid