Provider Demographics
NPI:1447676168
Name:SPAHR, STACEY MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MICHELLE
Last Name:SPAHR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-337-4105
Mailing Address - Fax:717-798-3407
Practice Address - Street 1:250 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1200
Practice Address - Country:US
Practice Address - Phone:717-337-4105
Practice Address - Fax:717-798-3407
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102912156Medicaid
PA346103Medicare PIN