National Provider Identifier
Stacey Lynn Johnville, RN
Stacey Lynn Johnville, RN is listed in the NPPES registry with a primary specialty of Registered Nurse in Williamson, NY and a listed phone number of (315) 589-4028.
Profile Overview
- NPI
- 1740564228
- Provider Type
- Individual
- Primary Specialty
- Registered Nurse
- Enumeration Date
- October 03, 2011
- Last Updated
- October 03, 2011
Practice Location
- 3820 Mystic Meadows Ln
- Williamson, NY 14589-9549
Phone: (315) 589-4028
Specialties
- Registered Nurse (163W00000X)
- Home Health Registered Nurse (163WH0200X)
Full Record
- NPI
- 1740564228
- Entity Type
- Individual
- Last Name
- Johnville
- First Name
- Stacey
- Middle Name
- Lynn
- Name Prefix
- Mrs.
- Credential
- RN
- Provider Other Last Name
- Petterson
- Provider Other First Name
- Stacey
- Provider Other Middle Name
- Lynn
- Provider Other Name Prefix Text
- Miss
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 3820 Mystic Meadows Ln
- Mailing City
- Williamson
- Mailing State
- NY
- Mailing ZIP Code
- 14589-9549
- Mailing Country
- US
- Mailing Phone
- (315) 589-4028
- Practice Street Address
- 3820 Mystic Meadows Ln
- Practice City
- Williamson
- Practice State
- NY
- Practice ZIP Code
- 14589-9549
- Practice Country
- US
- Practice Phone
- (315) 589-4028
- Enumeration Date
- October 03, 2011
- Last Updated
- October 03, 2011
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Registered Nurse (163W00000X), Home Health Registered Nurse (163WH0200X)