Marriott, Stacy Rae

Marriott, Stacy Rae is an individual health care provider with primary practice located at 12860 Troxler Ave , Highland IL 62249-2898. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Marriott, Stacy Rae can be contacted via phone (618) 651-2810.

Contact Information

Primary practice address
12860 Troxler Ave Highland IL 62249-2898
Phone: (618) 651-2810
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209019083 Illinois

Profile Details

NPI number 1255981528
LBN Legal business name Marriott, Stacy Rae
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 18th, 2019
Last updated Jul 11th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255981528 NPPES
Illinois Other 209019083 LICENSE

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